Make the Most of Massage

Category: Advanced Massage Techniques/Information

How to Do VERY Precise Pressure
There are benefits to treating a tight/tender area with very precise pressure. One, you can sometimes only find the “That’s it!” spot with very precise pressure. Another is that very precise pressure is a more thorough treatment than a massage with less precision. Most clients appreciate thoroughness. If you’ve backed off very precise pressure because it hurts your body or it feels intimidating, here’s how to change that.

Precise Versus VERY Precise

In general, I use precise pressure to find areas of tender/tightness. I use a variety of body parts, from big (forearms and fists) to small (thumbs and fingers) to apply precise pressure.

I use VERY precise pressure to further examine the tender/tight area. However, I only use smaller body parts (thumbs, fingers, massage tools) to apply very-precise pressure.

While I’m examining the tender/tight area with very-precise pressure, I may find a spot within that area of pain that is more tender or is tighter than the rest of the pain area. (Clients sometimes shout out “That’s it!” when I hit it.) I then treat the “That’s it!” spot using very-precise pressure.

Here’s an example. Ali comes in with neck and shoulder pain. Using my knuckles around the scapula I find the locus of his pain area in his levator scapulae attachment (precise pressure).

Next I start examining the area of pain in the levator scapula attachment with my middle knuckle, looking for that exquisitely tender or tight spot (very-precise pressure).

What to Use to Find the “That’s It!” Spot

If it hurts your hands to work with very-precise pressure, I have three suggestions:
1. Combine body parts.
2. Stack and/or brace (support) body parts.
3. Combine a massage tool with a body part.
Pictured below are my 3 favorite ways to deliver very-precise pressure.

Stacked Fingers/Thumbs

Try not to press. Instead lean into your fingers/thumbs. The bottom finger/thumb is the primary palpation vehicle.

Knuckle-Thumb

In this picture I’m directing my pressure into the middle finger of my left hand. You’ll notice that my right thumb is bent to fit in comfortably next to my left middle knuckle. This is not a mistake. In this case, my thumb’s primary role is for palpation, not for delivering pressure. My right thumb’s companion four fingers form a loose fist. They take most of the weight that I put on that hand, not my thumb.

Tool-Thumb

In this picture my thumb is a support, guide and the primary sensing instrument. I’m directing most of my “leaning” pressure into the tool, not my thumb.

How to Find the Spots

The way I find the tight and tender spots within the area of pain is by creating contrast. I can create contrast by the direction, length and speed of my palpating stroke.

When I’m palpating Ali’s levator scapulae attachment, I start by going across the grain of the muscle to give me enough distance to “flip” over a potential tight spot. My stroke is going to be fast enough and long enough so that I can feel the full shape of the tight/tender area. If I’m still having trouble feeling anything, I’m going to press deeper as I do the faster, longer stroke.

Going Very Precise

Once I find the tender/tight spots, I’m going to systematically investigate the areas using combined body parts, stacked/braced body parts or a massage tool and finger/thumb combination.

Next I’m going to use very precise pressure to work hyper-tender or hyper-tight spots within the pain area.

When applying very precise pressure I usually 1. press, 2. press and pull or 3. press and reciprocate. A massage tool combined with finger or thumb is insanely precise. In this video, I demonstrate how to press, press and pull, and press and reciprocate using a massage tool: T-Bar and L-bar: 3 Ways to Work Muscles Video.

Also, I like to work the pain area and the “That’s it!” spot from different angles. Lots of my clients love this.

Too Much

When you’re doing very-precise pressure, you run the risk of overworking the area. I usually can avoid this by revisiting the area instead of spending a long period of time there.

I also use a pain scale system approach when I’m unsure of the therapeutic pressure that I should be using. Here’s a quick video tutorial: Pain Scale System Video.

Lastly, I check in with the client to see how she’s feeling about the area I’m working on.

Checking in is not foolproof. The client may not have a mental gauge as to what feels like good pain and what feels like bad pain. When in doubt, move off—unless the client knows exactly what works for her.

Making Very Precise Happen

Here’s the short version for working with very precise pressure:
1. Find the pain/tight area by creating contrast.
You can create contrast by making your exploratory stroke longer and faster than you normally would. If you need more contrast, press deeper as you do your exploratory strokes.
1. Choose a body part combination that doesn’t cause you pain when you’re pressing.
My favorites are 1. Stacked thumbs, 2. Knuckle and thumb, 3. Massage tool and thumb.
1. Systematically work the pain area and the “That’s it!” spot (if there is one) by pressing, pressing and pulling or pressing and reciprocating.
Being very precise can help your client with her pain condition and doesn’t have to cause you pain.

Massage Tools Online CEU Course

If you want to be able to use a massage tool with every massage so that you can save your hands and deliver focused, precise pressure like nobody else can, this online course will get you there.

I taught it live for many years and now I’ve made the online version, There are lots of videos and if you have any questions while you’re taking the course, you can always ask me (mark@makethemostofmassage.com).

Check it our here: How to Use Massage Tools (Fearlessly and Effectively).
December 3, 2021
How to Palpate without Palpating
I stunk at palpation in massage school. All my classmates found the tight spot on the massage model right away. When it was my turn, if I didn’t find the tight spot by the third pass, I would pretend that I did.

My palpation skills did improve over time (hallelujah!), but they could have improved IMMEDIATELY if someone had explained to me the key to finding the most important tight and/or pain spots (the ones your client wants you to address).

The key is to pay attention with your eyes and ears.

The MT Measure

It makes sense that we, MTs, measure how skillful we are by what we pick up through our hands. But what we pick up through our eyes and ears will allow us to zero in on the tight/pain spots that our clients wants us to address quickly and ensures that we’ll never miss them.

In My (Simple) Secret to Pain Relief Massage I talked about how to find the client’s pain spots before the client is on the table. Now I want to share a detailed example of putting “palpating without palpating” into action.

Ian the Ex-Runner

I didn’t know what to expect when I walked into Ian’s running store. We had made an appointment to talk, but that didn’t mean he was a proponent of massage. It could be that he was just looking for some freebie massages to help keep his customers happy. Fortunately, that wasn’t the case. Ian was waaay into massage.

He asked me questions about the kind of massage I did and he talked about the times he got massaged. Not surprisingly, he had a strong opinion on what made a good MT. To him, a good MT should be able to find problem areas and tight spots by just using her fingers.

I Got This

Immediately I offered to do a free massage on Ian, knowing our future business connection rested entirely on whether I could find his pain spots.

When I went home, I told Lisa, my wife, that I’m going to hit a home run with Ian.

Why was I so confident?

Because, unknowingly, Ian told me the exact location of his pain spot.

Bad Hammy

Ian was once was a competitive runner but at one point he tore his hammy really bad and it took him about a year to get better. After that, anytime he’d try to run a marathon, his hammy would seize up midway through the race.

“It’s like a rock,” he said when I had met him. “You’ll find it.” But he didn’t tell me which leg he had injured.

Hmm…I wanted to make sure that I’d find it. Normally, I would ask the client to show me exactly where the injury is, but if I had asked Ian, I would have lost cred in his eyes. So I began to ask open-ended questions, like “What happens when it seizes up?”

At least two times when Ian was talking about his hammy, he reached down and grabbed his right hammy, midway between his knee and buttock. Now I knew the side and location of his old injury.

Wait…There’s More

I was in a time crunch that day and had to leave his store before we could finish our conversation. But I wrote down important points regarding our conversation in my cell. Then before I was scheduled to work on Ian, I went back to his store to drop off my cards. Ian and I had another conversation.

This time Ian talked about his bad knee, probably compensation from his hammy injury he thought. Again, I probed with open-ended questions, like: When does it bother you the most?

It turns out that the combination of injuries (hammy and knee) made Ian switch from running to cycling. And now his neck and lower back bothered him more than his hammy. As he talked about his current pain spots, he grabbed his neck, the C1 – C3 area.

I updated my notes when I left his store. Unless he had a new issue the day I was going to work on him, my game plan was to work his : 1. Neck, 2. Lower back, 3. Right hamstring.

Batter Up!

With all that information, it was nearly impossible for me to screw up. And on massage day, Ian was amazed that I knew exactly where to go. It wasn’t just a home run. It was an out of the park home run because I had asked open-ended questions, listened and watched.

Palpation Without Palpating Checklist

Most people are not going to test your palpation skills. However, that doesn’t mean a client is going to volunteer all the information that you’ll need in order to find her pain spots. Here’s my checklist for Advanced Palpation Without Palpating:
1. Before you drill down with specific questions, ask open-ended questions.
If you ask too specific questions in the very beginning, you may be narrowing your search too soon. That was the case with Ian. After the first meeting I drilled down too fast because I was in a rush and I had assumed that his right hammy was his number one priority. But during the second meeting when I had more time to ask open-ended questions, I found out that his neck and lower back were higher priorities.
1. Watch for clues.
Recently a client talked about general shoulder pain, but for whatever reasons, wouldn’t tell me where it was. However, she did reach back to her right levator scapulae attachment and upper rhomboid area. That was the clue I needed and once on the table, I found her pain spot immediately.
1. Write things down.
It’s not disingenuous to write down information that a client tells you so that you can incorporate it into your conversations and game plan. In fact, it makes for great therapeutic rapport. If you struggle with therapeutic rapport, check out A Quick Way to Connect with a Client.
1. Review notes before you see the person again.
If I hadn’t reviewed my notes before I saw Ian the 2^nd time, I wouldn’t have been able to facilitate the conversation to the point where I actually got the order of his pain issues correct.

Tell Me Your Success Stories

There’s no getting around that at some point you’ll need to find the pain spot with your fingers. But through asking open-ended questions (before you drill down with specific questions), listening and watching, you can make it a heck of a lot easier on yourself and be confident that you will find your client’s pain spots.

Need More Help?

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July 24, 2021
How to do One Hand Massage
I give my mom credit for helping me embrace one hand massage.

When I was a kid I’d sometimes give her the sass face, and she’d say: Your face is going to get stuck like that!

Yikes!

I stopped.

For a while. Then I decided to check in the mirror after I made the sass face. Hmm…nothing seemed to be stuck.

Many years later in massage school I was taught to keep two hands on the client all the tiime.

Why?

I’m not entirely sure…maybe because the client was paying for two hands, not one.

Anyway, I did two hand massage forever. Then one day my shoulder hurt and my subconscious must have remembered my mom’s horrible, life scarring lie to me about my facing freezing as I sassed her, and I lifted one hand off my client and continued the massage.

Interestingly, my pain went away. And when it was time for my client to pay, he didn’t demand a 50% refund.

Thanks to my mom, one hand massage has made me a durable MT and kept me out of pain.

One Hand Massage Is Not Complicated

One hand massage is not a massage modality.

It’s a strategy.

Here’s the strategy: at select times when doing static pressure use one hand.

Here are two things you’ll need to do:

One Hand Massage Basics

(1) Lean to generate pressure.

That means you’ll need to have your table height set so you can effectively leverage your body weight. onto the client. More about that here: Table Height is Everything.

(2) Press with a with a thumb, knuckle(s), fist, fist-thumb (same hand), or massage tool.

We all know what knuckles and thumbs look like, but a fist-thumb may be new for some. Here it is:

A have a very relaxed hand when using a fist-thumb. Notice that my fingers are not balled tight.

With a fist-thumb you can adjust where the focus of the pressure goes by simply directing more pressure into the fist or thumb.

Okay, Mark, we’re getting a little deep here. Before I invest anymore eyeball time into this article, how’s this going to save my body?

Fair enough.

One Hand Massage Saves Your Body

The first way it will help save your body is pretty obvious.

1. You can rest the hand that’s not working.

A 15 or 30 second break is sometimes all your fingers need to feel less taxed. And if you become ambidextrous with one arm massage, you’ll get to rest both hands during the course of a massage.

2. You can change positions.

When doing a massage stroke, you either face the direction of the stroke.

Back stroke from lumbar to cervical.

Or you don’t face the direction of the stroke.

Back stroke from lumbar to cervical.

Either way, both hands are down and you’re locked into one position.

This means that you glide in that one position.

You press in that position.

You sort of become that position, right?

But look what happens when you switch to one hand.

You can put your body in a different position and get a break from having two hands down. And here’s the bonus.

3. You can make postural adjustments and stretch.

Think of one hand massage as an office workstation break. It’s time to get up from your desk and stretch.

For us, MTs, it’s a time to be less hunch-y and more vertical.

If you breath in and lift your rib cage up while doing one hand massage, you can reset your posture.

And if you raise the other hand, you can reach up, extend your back and counter chronic, back flexion.

Whoa, Mark! You’re getting a little carried away here. Remember, you’re actually doing a massage.

Hey, I’m not slacking.

My pressure is precise. And I’m leveraging my body weight with which allows me to sustain any pressure with minimal effort.

One Hand Massage Example

Here’s an example of one hand massage in action.

Your gliding with deep pressure on Maria’s back. You hit a tender spot and she wants you to hold that deep pressure.

You do. But your body has been in that one massage position too long and things are starting to cramp up.

So you switch to a one-handed position and lean into the tender spot.

She asks for a little more pressure. You move your body so that you’re in the best position to transfer your body weight. Then you lean in.

In this picture I’ve maneuvered so that I can effortlessly lean in with all my body weight if need be.

Now I’m adding the stretch.

Oh, one more thing. You can even throw in a tool.

One Hand Massage Quick Start

If you want to add one hand massage into your work, start with areas that are easy for you to access with one hand.

For me, these areas are neck, back, and hammies.
1. Find a tight/tender spot.
2. Lean in with one thumb, knuckle(s), fist, fist-thumb or massage tool.
3. Adjust your body position so that it feels comfortable.
4. Make postural correction and/or add a stretch.
To transition out of one hand massage, simply move your feet so that you can comfortably put the other hand back down. Then continue on with two hands until you need another break.

If you need a little more motivation to keep you going, jump in my email group. I’ll send you links to updates, tutorials, workshops, downloads, everything! It’s free and you can opt out whenever you want:-)

Massage Pain-Free

It took me a while (like 20 years, ugh) to figure out how I could massage efficiently and effectively without being in pain. But now in my 50s I can comfortably do more massages than I could in my early 30s.

The trick?

Steroids.

Haha,

The trick is not a trick; it’s actually a series of strategies and techniques that allow you to maximize your work effort while minimizing stress and strain on your body which I write about in my upcoming book, The Pain-Free Massage Therapist, due out July 10. .

You can read about that here.

Have a question? Email me at mark@makethemostofmassage.com.
July 2, 2021
Massage Deep Tissue Techniques
Here are my favorite massage deep tissue techniques for pain relief and relaxation massage—that are effortless to do and don’t hurt my body.

The “don’t hurt my body” part is vitally important because if you’re killing your body doing deep tissue massage you’re either going to stop doing deep tissue or you’re going to continue to kill your body and resent your clients who want deep tissue work.

So, here are three deep tissue techniques that I do all day without being in pain.

By the way, after I show you the techniques, I’m going to explain the strategy behind each one. Once you understand the strategy you can develop your own pain-free, deep tissue techniques.

Here’s what we’re going to cover:

(1) Upper-Trapezius Non-Squeeze Release

(2) Rotatores and Multifidi Ischemic Compression Release

(3) Seated IT Band Glide/Press Release

1. Upper-Trapezius Non-Squeeze Release

In neuromuscular massage therapy (NMT) training I learned a great technique for releasing the deeper tissue of the upper traps.

The client is prone. With one hand you grasp the top edge of the trapezius so that your four fingers are wrapped around the superior, anterior edge and your thumb is on the posterior side of the upper-trap.

In this hand positioning you’re going to grip the upper trap and then “unfurl” the trap edge by moving your fingers towards you and your thumb away from you.

Once you get the technique down you can exert very focused pressure in the deeper tissues of the upper trap.

The goals of the NMT trap release are to deactivate hard to get to trigger points and to change ischemic conditions in those areas.

Though I don’t subscribe to NMT theory any longer, from a pain relief and relaxation massage perspective, I like the NMT trap release because it’s pain relieving and relaxing to clients.

But there’s a problem with the NMT deep tissue trap release: It beat the dog poop out of my hands.

This caused another problem. I couldn’t cut it out of my massage routine because a chunk of my clients were used to the NMT upper-trap release and loved it. So I needed to come up with a version that didn’t kill my hands. And that’s what I did.

Squeezing and rolling with one hand was what caused hand pain when doing the NMT Upper-Trap Release. So, instead of using one hand, I decided to use two. And instead of squeezing, I pressed with two hands.

By using two hands I could still roll and “squeeze” (now press) the tissue with focused pressure which was what made this NMT technique so effective in the first place, but without straining my hands.

In addition, for clients with very thick upper-traps, I added a massage tool which allowed me to press with enough force to reach the deeper tissues of the upper-trap.

Here’s what that looks like:

Play with getting really specific with your pressure. It’s amazing how focused your pressure can get when pressing between two hands.

Now, I want to show you a deep tissue technique for back muscles, specifically for rotatores and multifidi. It’s my favorite deep tissue technique.

2. Rotatores and Multifidi Ischemic Compression Release.

The multifidi and rotatores are in the lamina groove. Early on in my career, I shied away from anything close to the spinous processes. But neuromuscular therapy taught me that these muscles can be influenced and clients REALLY like getting them worked.

The Deep Back Muscles

Here are the multifidus and rotatores:

They multifidus stabilizes joints within the spine. The rotatores lie underneath the multifidus and are involved in postural control.

The great thing about the deep tissue technique that I’m about to show you is that you can do this technique through clothes (like when doing demo massages). Being able to deep tissue massage during a chair massage event is a great way to market your skills and has helped me net clients.

4 Steps for Deep Tissue Rotatores and Multifidi

Here’s how to get comfortable working these deep muscles.

Step #1: Find the spinous processes.

Once you find the spinous processes, you’ve won the battle.

By the way, don’t be scared of the spinous processes. They are your friends (reference points).

Step #2: Go just lateral of the spinous processes (maybe 1/2 inch).

For extra assurance, keep in contact with the spinous processes. You can use fingers from your pressing hand or non-pressing hand to maintain contact.

Step#3: Press down into the lamina groove with a thumb/finger or body parts combination.

Here’s what that looks like:

(In the video I use the term power tools. Now I call power tools “body part combinations”.)

You may have noticed that in the video that my table is low and that I’m leaning generate deep pressure.

Why?

Because when you lean you can transfer your body weight into the area you want to work. In other words, you can use your body weight to generate pressure.

Leaning makes delivering static pressure in the lamina groove effortless.

To learn how to lean to generate pressure, go here.

As you’re learning to calibrate your pressure in the lamina groove, you may first want to use a pain scale system.

Here’s the pain scale system I use: I tell the client to think of a pain scale from 1 to 10 where 1 is not much pain and 10 is a lot. When you press on an area, you want your pressure to feel like it’s registering in a 3 to 4 range (in acute pain areas) or a 4 to 5 (in non-acute pain areas).

Here’s my pain-scale-system tutorial video if you want to take a deeper dive: Pain Scale Video.

When I have a client who responds well to deep pressure in the lamina groove, I use a massage tool to save my hands.

The massage tool also allows me to deliver deeper and more focused pressure.

The disadvantage of using a massage tool is that you will lose some sensitivity, but that can be remedied if you use a guide finger.

Go here if you want to learn how to use a massage tool in the lamina groove.

Step #4: Be thorough and relaxing with each press.

When I say thorough, I mean really explore the tight and/or painful areas with ischemic compression. Sometimes you may find the “that’s it!” spot, which when pressed with the appropriate amount of pressure may provide instant pain relief.

When I say make it relaxing, I’m talking about the speed you move from point A to point B.

Don’t rush it.

Zen it.

The focused, deep pressure can be very relaxing to many. Jump from point to point quickly and you’re undoing the relaxation benefit.

Here’s a trick for moving at a relaxing pace: Stay relaxed yourself because if you’re relaxed when doing deep tissue work, then you’re probably moving at a pace which is relaxing to your client.

Though ischemic compression in the lamina groove is my favorite deep tissue technique, this next one is a close second.

3. Seated IT Band Glide/Press Release

For most of my massage career I hated working IT bands because they were so hard to get to without having the client turn on her/his side. Then I’d have to deal with the sheet and the IT band was now on an angle and if I was using my forearm it was looking more like I was trying to block a linebacker than do a massage…and the list went on.

Give me an IT band deep tissue release that is easy to do, doesn’t hurt my body and is effective.

Here it is—the Seated IT Band Glide/Press Release.

Wait, Mark, how can you generate enough pressure in the IT band when you’re sitting?

You lean.

Just like when you were standing and leaning, you can lean when you’re sitting, but when you’re sitting, you’re leaning from the torso.

And, yes, you will be able to generate all the pressure you need to and then some.

For a broad glide, you can use your fists or knuckles or a fist-palm.

For more focused pressure you can use a knuckle, thumb or a massage tool.

Or you can use body part combinations like a knuckle thumb.

The great thing about seated deep tissue IT band work is not only is it easy on your body, but the body part combinations and tools that you can use to get the job done are practically endless.

Here’s how I do the Seated IT Band Deep Tissue Release:

Remember that in the beginning of this article I had said that the three deep tissue techniques that I was about to show you had strategies behind them and that you could use these strategies to develop your own deep tissue techniques that wouldn’t hurt your body?

Well, I want to explain those strategies to you so that you can walk away from here armed with the building blocks to help you create deep tissue techniques just for you.

Strategies for Pain-Free Deep Tissue Massage

Here are the strategies behind my deep tissue techniques that save my body:
1. Squeeze less. Press more.
2. Lean to generate pressure.
3. Use multiple body parts (and use tools) to deliver focused pressure.
Let’s take these three strategies and start experimenting.

TFL Deep Tissue Release

The TFL is a tough muscle to access. It’s small and requires very focused pressure, which begs the question: How do I massage the TFL with deep pressure without killing my hands?

In the video below I take the 3 strategies—squeeze less, lean and use multiple body parts/tools—to create a deep tissue technique that doesn’t hurt my body.

Are you starting to see how these 3 strategies can be applied universally to all body areas that you are massaging?

Here’s another example of deep tissue work in the tibialis posterior where I use the 3 strategies (more press, lean and use multiple body parts/tools).

By the way, this massage example is not part of what I would do during a relaxation massage. It would be what I would do if someone came in with a tibialis posterior issue.

Massage Deep Tissue Techniques In a Nutshell

So, I showed you three of my favorite deep tissue techniques—(1) upper-trap non-squeeze release, (2) rotatores and multifidi ischemic compression release, and (3) seated IT band glide/press release.

To get to the deep tissue of a muscle, you need to be able to exert a certain amount of pressure. Sometimes that pressure needs to be precise.

Once you can exert the appropriate amount of pressure you can hold that pressure, glide with that pressure or do other movements with that pressure, like cross-fiber work.

To be able to hold that pressure consistently your body can’t be straining. In fact, your body needs to be relaxed which means you need to be using strategies that make deep tissue work easy.

Leaning, less squeezing and more pressing, and using multiple body parts/tools to deliver pressure are strategies that will take the strain out of your body when doing deep tissue work.

If you work with these 3 strategies you will not only save your body when doing deep tissue work, you’ll start to develop your own techniques that are unique to you and your style of massage.

Online Deep Tissue CE Class

If you want more help, I have a online, home study, CE course that will give you the platform to create your own deep tissue techniques and get competent with deep tissue work without hurting yourself.

It’s NCBTMB-approved and you can check it out here.

And if you have a question about my deep tissue techniques or anything else, email me anytime— mark@makethemostofmassage.com. 🙂
December 19, 2020