From my experience, there seems to be a misconception regarding the depth of pressure required when it comes to massage therapy.  Most patients believe there are only two types of pressure; light and deep. A statement I regularly hear is, “Well, it has to hurt in order to feel better, right?” or “No pain, no gain”.  In the span of my career I’ve had to educate almost every patient regarding what depth is appropriate according to their body type, pain tolerance and the type of injury they possess. It should be noted that there is rarely any justification for extremely painful massage, unless it clearly produces a better result than gentler treatment for the patient — which is rare!

As a female Registered Massage Therapist, the depth of my pressure is often underestimated based on my gender and height.  Most seasoned RMT’s will tell you it’s not about the amount of pressure we use to engage a muscle, it’s about angles, positioning and how to effectively use your body weight.  I’ve been fortunate enough to develop the intuitive ability to gauge how an individual’s muscles are going to respond to a certain depth and what kind of “kickback” a patient is going to experience based on the pressure applied. I could very easily, without exerting a tremendous amount of pressure, leave someone experiencing delayed onset muscles soreness (D.O.M.S.) for 6 to 8 days post treatment.  This achieved without even working at my “deepest.”

Each individual I treat can handle varying degrees of pressure.  The same patient for instance might be able to withstand relatively deep work on a Tuesday but the same pressure applied on the Friday of the same week can feel uncomfortable. Furthermore, If a patient hasn’t received any manual work for a few months or even a year, the relative applied pressure they are able to withstand will likely have drastically changed.  As such, I remain vigilant to continually adjust applied pressure throughout a treatment particularly as different areas of the body can withstand different levels of pressure.  For example, the back of an individual can typically withstand higher levels of pressure, however that same pressure applied to the calves would likely result in D.O.M.S. post treatment.   In order to mitigate an adverse response, prior to tx, I discuss with patients the pros and cons of pressure. I also explain how I’m going to work for the duration of a session, that I will adjust pressure accordingly and that during a subsequent session there may be an increase in pressure in relation to how they respond. During a treatment, I order to monitor how a patient is responding, I observe signals such as increased breathing, fidgeting, lack of breathing and obviously verbal cues.  The aforementioned points become critical in situations where a patient has an existing injury while receiving my therapy. By using my protocols, there is a reduction of the likelihood of confusing symptomatology associated with an injury with that of D.O.M.S.  

What my years of experience have taught me is that a patient, even the same patient, may not be able to endure the same amount of pressure day in and day out. Stress, lack of sleep, mood disorders, depression, medication use, injuries and menstrual cycle are just some of the contributing factors that can affect how a patient responds to pressure. That said, the number one priority of a therapist, regardless of their discipline or level of education, should be client comfort. Never be scared to speak up and tell a therapist you need less pressure or that there is pain during treatment. A good practitioner will adjust accordingly and, if they do not, it may be time to find someone who will!

Author:  Lesley Andress, RMT