As you will discover from reading the case studies later in the chapter, not all clients approach a therapist seeking deep tissue massage. In many cases, it is the therapist rather than the client who decides that this form of massage might be more beneficial than general Swedish massage—that it might result in a better treatment outcome.
When a client specifically requests deep tissue massage, there are some questions you should ask prior to treatment, in addition to those questions you normally ask when taking your client’s medical history. You will not want to ask all these questions of all clients, and you should adapt them to each situation. Select from these questions the ones that are relevant to your client and feel free to phrase them in your own words.
TIP
For more information on how to take a client medical history, see Soft Tissue Release (J.Johnson, 2009, Champaign, IL: Human Kinetics).
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The first six questions pertain to new clients who have had deep tissue massage before; the seventh question should be asked of all clients wanting deep tissue massage.
1. Why did you have deep tissue massage?
With this question you are trying to determine why the client wants deep tissue massage again and what their expectations might be of the deep tissue massage treatment you will provide. Do they want deep tissue massage because they previously found it pleasurable? Or simply because they always have this type of massage? Or do they think they ought to have deep tissue massage because the last therapist they saw told them it was a good treatment for a particular condi-tion they have? This last reason is quite common in clients seeking treatment for the rehabilitation of sporting injuries. Often another therapist has indicated that the only real solution to very tight muscles or a tight iliotibial band is deep tissue massage.
2. Who performed the massage and for what reason?
Knowing who performed the treatment and why is helpful. Was treatment for a particular condition, such as a restricted joint or particularly tight-feeling muscle?
If so, is this what the client wants to have treated again? Or was deep tissue mas-sage simply the preference of the previous therapist?
3. How was the massage applied?
Although you cannot replicate the exact treatment style and routine of another therapist, and might not wish to, knowing when something worked well comes in handy. Was application part of an oil massage? Or was it through clothing as part of a seated chair massage routine?
4. Was this a recent treatment or did they receive it some time ago?
When did the client receive the treatment? Last week? Last month? Last year?
If the treatment was a long time ago, say, over a year, and the client has not received a treatment since, why? Was he or she too busy? Was there an illness or a contraindication? Or did something put the client off having massage again?
When clients receive their first deep tissue treatment from a therapist who believes in the no-pain-no-gain approach, they might come away feeling this form of massage was too deep. They might have even suffered bruising. If so, they are understandably reluctant to repeat the experience, no matter how badly they feel they need treatment. It might take them months or longer before they seek treat-ment from another therapist. In such a case, you know you have to pay special attention to gaining and maintaining rapport with the client, reassuring him or her that deep tissue massage need not be painful. Conversely, you might meet a client who has enjoyed deep tissue massage. In either case, you will want to solicit more information about the treatment itself.
5. How did the previous treatment feel? Did they enjoy it?
If a client has had deep tissue treatment before and enjoyed it, you can try to repeat that treatment or even improve on it. The more information you can
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cover about the treatment, the better. Was it deep enough? Did any aspect of the treatment feel too deep? Were there aspects they particularly liked or disliked? If a client answers, ‘I loved it, but it was painful on my legs’, this prompts further questions. What does the client mean by ‘legs’—the regions from the knees to the ankles, as defined in anatomy, or the whole of the lower limb? Was it the front or the back of the legs or both that were painful? Clients often provide a lot of information in one answer. For example, they might say, ‘It hurt on the front of my leg, here, and the therapist said that it might be because I’d been running a lot this week, and when I told him it hurt, he did it less hard. It was okay after that.’ From this kind of information there is much to glean that can be helpful to you in the future.
6. How did the client feel following treatment?
We all hope our clients express positive feelings following treatment, saying things like, ‘I felt great. Everything felt better, and my shoulders were no longer stiff.’
You don’t want to prompt the client but do also need to know if they experienced adverse effects such as bruising, DOMS or lightheadedness. If they report, ‘It was ok, but I felt sore for a few days’, this raises the question, ‘Why are you returning for deep tissue massage?’ Do they want to feel sore? Do they think they need to feel sore for the treatment to be effective? Or are they hoping to enjoy the sensation of deep tissue massage this time without feeling sore again afterwards?
7. What do you want from this treatment?
Does the client want deep tissue massage on all parts of the body? Or are there parts of the body to which they don’t want to receive deep tissue massage? (See case study A, p. 193, for an example of a client who had preferences such as this.) Having read the safety guidelines on page 24, you will know there are some areas or structures to which deep tissue techniques should not be applied. However, the client might report disliking massage when applied to their quadriceps but liking it when applied to their hamstrings.
Tests
If you are using deep tissue massage as part of a programme to help improve the range of motion in a joint, you will find it helpful to first assess this range, then perform your treatment using deep tissue techniques (plus other modes of treatment, perhaps), and then to reassess the joint. Which tests you perform obviously depends on the joint you are treating. If it is the knee joint, for example, you will need to test flexion and exten-sion; if it is the ankle, you will need to test plantar flexion and dorsiflexion as well as inversion and eversion.
Most textbooks on musculoskeletal assessment include information on joint testing.
To discover normal joint ranges, refer to The Clinical Measurement of Joint Motion, edited by Walter B. Greene and James D. Heckman and published by the American Academy of Orthopaedic Surgeons.
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