Business and the weather have both been brisk lately. It seems no matter how hard I try, I can’t get truly warm. I hope everyone else is having an easier time than I am staying warm. Thank goodness for goose down booties and polar fleece.

This month I wanted to write about giving your massage therapist feedback, especially during sessions where a lot of chronic pain and injuries are being addressed. It’s very important to communicate the amount of stretch you’re feeling during a session for passive and assisted stretching. In order to get the most out of your massage, it’s vital to let your therapist know when stretches need to decrease or increase in angle, and to let her know when the pressure needs to be adjusted.

- heather wibbels (615.294-6672)

Every massage therapist wants to make sessions perfect for her/his clients. Feedback from the person receiving the massage makes that possible. Without verbal feedback, the massage therapist relies on palpation and observation of the client’s body to know when pressure needs to be lighter or when stretches need to be reduced. Verbal feedback can be much more specific about what is uncomfortable or what needs to be changed in the stretches or pressure levels.

While some people may think giving feedback to the massage therapist is pushy or that it interrupts the flow of the massage, therapists rely on verbal feedback to make the massage better for you. The body’s response to pressure and stretches changes according to the part of the body being worked and the things going on for the client that particular day. Although massage therapists are generally good at observing non-verbal response to their touch, most of us aren’t psychic, so verbal feedback insures we give clients the massage they want.

Feedback on Pressure
Feedback on pressure is especially important when the therapist is working on tight, injured or chronically painful areas. In many cases, these parts of the body need lighter pressure. Sometimes, after a specific amount of lighter work, the muscle will open up and allow much deeper work. The change is sometimes so subtle the massage therapist can’t tell the muscle is ready for deeper work. Speak up and let her know.

Other times, lighter pressure is perfectly effective to work on the tension without needing to go deep into the muscle. Going too deep into the muscle causes a guarding response that keeps the muscle tight and tender, and the body will “push” the massage therapist out of the muscle until the pressure is reduced to a lighter level.

What the Client Feels – How to Find the Good Stretch
On the receiving end, a good stretch should feel a little achy, not sharp or piercing. It feels like the muscle itself is relaxing and lengthening into the stretch. Joints or the path of tendons over joints may feel more sensitive than the muscles targeted by the stretch. For instance, often when stretching the forearm, clients feel the sensation of stretch more across the wrist joint than in the forearm, where the muscles controlling the hand sit. In many cases, a muscle group (rather than one individual muscle) is tight, and the stretch may require a few different angles of pressure in order to stretch the muscle fibers of each part of the group of muscles.

When has the Stretch Gone too Far?
When you feel as if you need to hold your breath, push back against the massage therapist’s pressure, or start to wince you know that the stretch is going beyond the comfort zone. The stretch should never push beyond a “good hurt.” Do not let the massage therapist take the stretch too far. Just because your muscles and bones can move into that extension doesn’t mean that they should be pushed there. Many people think stretches need to be taken as far as possible as soon as possible. This can result in injury and forces the muscle into pushing back against the stretch to protect itself, negating the positive benefits of the stretch.

What a Massage Therapist Feels – Feedback for the Best Stretch
When performing a stretch, the massage therapist palpates for several things. First, the therapist searches feeling for muscle resistance to know when the muscles are starting to stretch. To the massage therapist, it feels as if the free movement of the joint slows a bit as the joint moves toward the limits of its range of motion. In addition, there is an “end-feel” as the therapist continues the stretch. It is the resistance felt at the end of range of motion at a fully functional joint. It feels final, and marks the place where bone meets bone or where the joint capsule no longer has any movement based on the physical structure of the joint. Between the first bit of muscle resistance and end feel is the optimal stretch. Finding that spot requires the assistance of the client with verbal feedback.

It is important for the client to relax. When the client assists by using his/her own muscles to push the stretch further or to hold the limb in place for the stretch it interferes with the massage therapist’s ability to detect muscle resistance. The action of the muscles in assisting the therapist in the stretch takes away the ability of the therapist to note when the muscles start to resist movement and move into a stretch. This is why it’s very important to be completely relaxed when being stretched in a massage.

When the Stretch Hurts, Say Something!
Sometimes the client hits a pain barrier before the massage therapist gets to any significant muscle resistance. At this point, it is important for the client to speak up and let the therapist know that a limit has been reached. Oftentimes, in areas of chronic tension or injury, the pain barrier presents no muscular resistance for the therapist to feel, and feedback from the client is the only way to discover it.

Sometimes another muscle speaks up before the intended target muscle gets to a good stretch point. In these cases, the client needs to tell the therapist so that she can work on massaging or stretching the other muscle in order to be able to stretch the originally targeted muscle.

Why the Massage Therapist May Not Go Far Enough.
If the therapist senses an end-feel to the range of motion, she will stop. In some cases, the client’s body may not recognize the sensation and push for the stretch to go further when it cannot. Sometimes, the massage therapist cannot distinguish between tight muscle resistance and end-feel, and the client will need to let the therapist know she can continue into the stretch. Usually, when I perform a stretch, I ask the client to let me know when they start to feel a good stretch. If I’m getting a massage, I tell the therapist, “Keep going until I say OK.” That lets them continue the stretch, but gives me ultimate control as the client over the intensity of the stretch.

Try Bracing the Torso for a Good Stretch
If you can’t get a good stretch, ask the massage therapist to brace the torso near the limb being stretched (usually bracing against the pelvis or shoulder girdle will help). This keeps the body from rolling or twisting to help reduce the effect of the stretch on the limb. Sometimes the joint cannot go beyond a certain point in the stretch because of a previous injury or a joint problem like arthritis. The client hits a pain barrier in the joint before the muscles can be stretched. In these cases, it’s probably best to either try another form of the stretch or settle for massage work on the muscle itself.

Make Sure Your Body is Relaxed
If you still can’t get a good stretch, make sure your body is fully relaxed at the site of the stretch. If you’re helping or holding, the massage therapist will not be able to push past your effort to get the muscle into a good stretch. Keep other muscles nearby from helping as much as you can. In some cases, assisted stretching once you’re dressed may be the best way to get the stretch. Make sure you wear comfy clothes to your massage if you’re planning on doing some stretches in case you want to do some of the stretches before or after the session.

When to Speak Up

• Generally, the massage therapist warms up an area with lighter pressure before going in deep. Give the massage therapists a few minutes to warm up the area before telling her to go deeper.
• If the massage therapist starts out too deep on an area, especially after it’s been warmed up, let her know right away.
• Sometimes the massage therapist will only do a few deeper strokes, and then will move on to a different technique that is easier on the muscles. Wait a few strokes before telling her to lighten up – she may only be doing 3 or 4 of those before moving on to something else. If she starts to concentrate on an area with pressure that’s too deep, just let her know to lighten up.
• Once placed in a stretch, if the discomfort level goes from a “good hurt” to something more extreme, speak up immediately, or move your limb out of the stretch. “That’s too deep” or “Try a little less of a stretch this time” will get the point across to the therapist.
• If the stretch is not going far enough, and the massage therapist has stopped moving the muscle into a deeper stretch, let her know. “You can go further” or “You can take the stretch deeper until I let you know” are both appreciated comments.
• If you’re unsatisfied with the pressure overall, and the therapist has finished a couple of areas of the body, let her know right away. She can adjust for the rest of the session.
• In some cases, the massage therapist cannot safely meet the client’s need for pressure. In those cases, the client should ask the massage therapist for a referral to someone else who does deeper pressure.

Massage therapists everywhere want to give their clients the best massage they possibly can. Speak up, let your therapist know when to use more or less pressure, and when to increase or decrease a stretch.