Addressing Client Concerns: Post-Massage Pain & Best Practices

Question
Jessica -

I have been massaging for nearly five years now, my specialties being Deep Tissue, Sports, and Myofascial Release - clinical work. I have recently worked with a woman who has both insulted and confused me. She contacted me about a month ago, seeking a deep tissue massage at the suggestion of her physical therapist, who said she had deep knots in her shoulders from tension that was a side effect of her shoulder injury. The only place I was not to work was on her delts, which were taped. This was nothing new for me, as I work with several injury rehab clients, so I booked an appointment with her.

At the start of the massage she was telling me that she had been receiving deep tissue massages for seven years until about a year previous, when moving had caused her to stop seeing her therapist. She insisted on a deep tissue massage, however I explained to her that it may be better to ease into those types of massages again, and I gave her a firm Swedish at best, working on her back for about forty minutes and spending the remainder of the hour on the rest of her body. She claimed to feel great afterward, and book another appointment.

At the second appointment, she stated that she had been so sore for four days after the massage that she could not even put lotion on her back. She wanted to try a lighter massage, which I agreed was a good idea. I began working on her shoulders, and noted to her that she did at least seem less tense, which is an indication that though it may have been sore for awhile, at least work was accomplished. She contradicted me, and said that her physical therapist was the one who worked the knots out (I know for a fact that the PT was only working with her shoulder, as I am well acquainted with the rehab center she is at and know that they do not do any additional work on their patients) and all I did was make it sore for several days. I held my tongue and said that it could be possible. After fifteen minutes of light Swedish, she stopped me and told me to work on other areas of her body. Not a problem, though a bit unusual, as most clients just let me work, but I accommodated her and spent the rest of the time on her arms and legs.

A few days after this massage I called to check in and see how she was doing. She claimed that she was still sore in her shoulders from the massage. I mentioned that this was strange, as I had only used light pressure for a small amount of time, and then she interrupted me stating that "No I did not" and she thinks that I "don't know the difference between a deep tissue massage and a relaxation massage." I politely apologized and wished her well finding what she was looking for, and then hung up.

I have performed thousands of massages, and not once, not even when I was a new therapist fresh out of school, had I ever received feedback such as this. I have worked for chiropractors, spas, PTs, and independently, and I have never received any complaints. I am well aware of the level of pressure that I am using with a client, though I encourage my clients to communicate if they are feeling any pain, which this woman did not (not on her shoulders - she mentioned an injury to her hand and a rough patch on her calf when the lotion absorbed too quickly, but neither of these were her complaints).

The insult to my skill level isn't my biggest concern, however, and I can ignore that. What concerns me is the fact that she was still feeling pain four days after a light massage that only lasted fifteen minutes. I have never heard of this. I've worked with fibromyalgia clients who have felt pain while I was giving the massage (which they communicated and I adjusted), but never after a massage. I've never had anyone tell me that they felt sore more than a day or so after, and those are usually DT and Sports clients, not Swedish. Is there any kind of condition that would cause this? She had no visible bruising, but complained that the pain was so severe she could not put lotion on her back during the time she was sore. I am genuinely concerned that there may be something wrong with this woman, because she was the one asking me for a deep tissue - insistent in fact - and then complained over a light Swedish. Have you, or any therapist you're acquainted with, ever heard of anything like this? I would be very pleased to have this explained. Thank you for your time.

- Kara

(Sorry about the length of the question)

Answer
Kara,

    First of all I want to say two things: no need to apologize for the length of your question. I write a lot and it also gave me a feel for what was going on. Second, I can see how caring you are and I think you are definitely in the correct field.

    From the sounds of your description, you and I perform similar massage work. I will say that my first and probably strongest instinct is that unfortunately we run into difficult clients; and your client seemed to want to be in control of the massage session. I'm glad to hear that you listened to your hands and used less pressure than she requested. She re-booked which is a good sign and she didn't cancel the session, she just reported back what happened. I find it excellent that you called back to check on your client a couple days after the massage.

    As you mentioned individuals with fibromyalgia would be in extreme pain after a deep tissue session or even a heavy pressure massage (it does vary, but I find it best to err on the lighter side since they are not able to pass toxins through their system easily). But if that were the case, she would have had a difficult time during the massage.

    I also want to say, you did nothing wrong. I'm assuming you had an intake form and if she did have a condition she should have brought it then.

    I personally have not seen anything (other than similar behavior) quite like what you explained. The only incident in my clinic that came close - the 4 days of pain afterwards, etc. was regarding someone who had performed a deep tissue that was most likely too deep.

    Do you have a Pathology book? Mosby's used to be my favorite (to skim through if someone had an illness/syndrome I was unfamiliar with)? Or for checking on things afterwards. I'm going to have you take a look at this site and see if you were working on this area: http://adam.about.net/encyclopedia/Bursitis-of-the-shoulder.htm
It is possible that your client had bursitis (remember I am not a doctor) and massage of an inflamed bursa sac could potentially cause the reaction she had. Since bursitis is a contraindication of massage therapy, its really a good thing that you didn't perform deep tissue. Remember, however, if she did have this or any condition she did not tell you.

    I truly believe you handled the situation as textbook case. I'll continue to rack my brain and research that subject for you. I also would be interested in knowing if she was tender around the bursa sac if you wouldn't mind sending me a quick note.

    Thank you for your question and I know I didn't give you that much to go on, but my best guess is that she is very picky and not the easiest client to work with (I so hate to say that). & my two suspicions at this point are 1)bursitis and 2)fibromyalgia.

Sincerely,

Jessica