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The Pressure Series: Part 2

What is the right amount of pressure for massage therapy?

As was discussed in Part 1 of this Blog, “Deep Tissue” massage is one of the most frequently requested modalities massage therapists are asked to perform. Now that we’ve covered some of the physiological reasons as to why Deep Tissue therapy is often not the most appropriate treatment option, I’d like to cover some of the other modalities that are effective for addressing a wide range of common soft tissue complaints.

When I am in session with a client, I rarely use one modality throughout the entire length of the session. Oftentimes a client’s body will need different therapies applied in different areas. What one area of the body might need will depend on my assessment of many factors: tissue tone, joint mobility, sensitivity of a particular area, acute or chronic injury, and tissue atrophy, just to name a few considerations. The following are some of the most common therapies I use in my practice: Myofascial Release, Passive Positional Release Therapies, Trigger Point Therapy, and Active and Passive Range of Motion. We’ll break down the why and how of these modalities next.

Myofascial Release (MFR)

As the name implies, this therapy is concerned with fascia. Fascia is a connective tissue that was, for a long time, poorly understood and regarded as a nuisance in surgical procedures. We’ve come to learn that fascia is hugely important in it’s supportive and sensory role in the body. It wraps, interweaves, and supports virtually every major structure in the body. It has the capability to become tight and painful just like a muscle, and dehydration of this tissue can lead to further discomfort, pain, and dysfunction.  MFR treatment typically uses no lotion on the client’s skin, as it is important for the therapist to contact the fascia at a very precise angle to get what we therapists call a good “hook.” Much like sticking a knitting needle into a sweater and pulling on it, hooking the fascia and stretching it affects a broad area of tissue. This therapy can feel very intense and deep to the client; clients will often tell me they feel a tug or a pull in an area far removed from where my hands are actually contacting their body. This therapy can be applied for just about every type of soft tissue complaint ranging from poor joint mobility to tension headaches.

Passive Positional Release (PPR)

This is a gentle therapy that is very nuanced and has many “cousin modalities” with different names: Orthobionomy, Strain Counterstrain, and Positional Release Therapy to name a few. All of these share a common theme of finding a position of ease or comfort for the area of complaint and then holding that position for a period of time. I use this therapy frequently with clients that come in with some sort of acute pain or injury such as whiplash or frozen shoulder. Our soft tissue houses several different sensory organs to detect and prevent against overstretch. This is a great safeguard against muscle tears, sprains, and strains. If we try to take an acutely damaged area into a stretch, we often will only renew the alarm signal to that area causing further tightening and pain. PPR gently shortens the tissue as much as possible and even sometimes compresses the joint capsule in question. This provides a great deal of laxity in the area (which can be a nice, non-threatening state for the nervous system) and can frequently allow for a soft tissue release that would otherwise be impossible with stretching or lengthening the tissue.

Trigger Point Therapy (TPT)

Trigger points are areas of dense tissue that are often extremely sensitive or painful when touched, many of us refer to them as “knots.” These spots often arise from repetitive activity injuries or from mechanical stresses such as working at a poorly organized desk arrangement. They can also be secondary to some other complaint such as a sprain or strain, arthritis, headaches, intervertebral disc issues, etc. A hallmark of trigger points is that they will often refer pain outside of the area in which they are physically located. For instance, a very common trigger point that I feel on a great number of people prone to headaches is located in the sub-occipitals (the little muscles at the base of your skull), but refers very intense pain to the temple or the orbit of the eye. TPT applied to these problem areas can effectively “turn off” this painful referral pattern. The therapist will generally hold deep, static pressure over a trigger point until the pain sensation diminishes or disappears completely.

Active and Passive Range of Motion (AROM & PROM)

These two therapies are useful for assessment purposes and to integrate into a session. During Active-ROM, the client moves their own body without the aid of the therapist, and during Passive-ROM the therapist will move the client’s body for them. The use of PROM in particular can be a great way to gauge if a client is unwittingly limiting their own range of motion in a particular area of the body. If I ask a client to test their neck flexion on their own, and they only move it a very small amount but then let me move it a much greater distance passively, that may indicate subconscious self-limitation of that area for some reason. This can be great information for client and therapist alike.

Now that you have a sampling of just a few of the modalities available to you as a client I hope that you’ll get a little more curious and explore a few more. The world of bodywork is virtually limitless, and therapists are developing new and creative modalities every day. The next time you stop in to Siskiyou Massage for a session, feel free to try out your newly learned lingo and ask for some MFR on your back or maybe some TPT on your shoulder!