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A 38 year old woman suffers permanent shoulder drop after a "deep tissue" massage caused damage to a spinal accessory nerve.

A 59 year old man suffers a deep hematoma, numbness, and swelling after being injured by a deep tissue massage to his hip.

A client tells a massage therapist that he wants more pressure. She complies. He again asks for more pressure. She complies. He again asks for more pressure. Unable to exert any more pressure with her hands, she resorts to using a hand-held tool to apply more pressure without hurting her joints. Shortly after, she receives an email from her employer that the client is suing their business, claiming that he was injured by the massage.

"How does massage work?"

My late Russian Massage teacher Zhenya Kurashova Wine asked this question at the beginning of my first class with her. We sat and looked at her blankly. No one raised their hand, no one offered an answer. What kind of a question was this, anyway? We never thought about this. You know, you put your hands on people and then . . . well, massage happens!

When it became apparent that no one was going to attempt to answer, Zhenya finally said, "I'll tell you how it works," and then went on to explain.

The labeling of nociceptors as pain fibers was not an admirable simplification, but an unfortunate trivialization under the guise of simplification. 

From Patrick Wall, eminent pain scientist and author of the gate theory of pain.

Ever since I got a website, I see a lot more pregnant women for prenatal massage. I don't know if there's a baby boom happening or if it's just easier for them to find me. I have learned that a lot of massage therapists don't do prenatal massage and many of the franchises will not accept pregnant clients, either. If a therapist has not been trained to do prenatal massage, they should certainly refer out to a therapist who has been trained. However, some of the reasons for turning down pregnant clients are based on unwarranted fear and misinformation.

Many massage therapists report that they have been told not to give massage to a woman during her first trimester. Some have been told that there is a risk that massage may cause a miscarriage. This is an absurd idea and is probably based more on fear of litigation (unfortunately, the U.S. is a very litigious society) than on any actual risk. Most women don't know they are pregnant until they are well into their first trimester. The only way we could completely avoid giving massage to women in their first trimester would be to refuse to massage all women of childbearing age. Certainly no one is advocating that.

People come to my office for a variety of reasons. Some come to relax and that’s great. I think if we all got a massage about once every three weeks, the world would be a kinder, gentler place. People would probably be nicer to each other, to their spouse and their kids, and maybe be a little more patient to the guy who cut them off on the highway without realizing it because his mind was on something else or he didn't see you in his blind spot. Massage for relaxation, to "downregulate the sympathetic nervous system" (tech talk for chill out,) for the pure enjoyment of it, is a fine reason to get massage. 

Others come because they’re athletes or musicians or have other reasons for wanting to keep themselves in top shape. They appreciate having a body that’s well-tuned, not held back by unnecessary tension or bothersome pain.

I see a fair number of pregnant ladies,. It seems a lot of massage therapists don't do prenatal massage. I welcome mothers-to-be. I love nurturing women during this special time of their life and enjoy helping to relieve the temporary discomfort that often accompanies pregnancy.

Most of us were brought up, professionally, with an idea of "deep tissue" and the need to "break up adhesions," "stretch fascia," and generally "fix" the meat and bones. Along the way, some of us discovered pain science, neuromatrix theory, and the realization that it is the nervous system that creates tension, creates the sensation of pain, and it is through the nervous system that one corrects it. We came to understand that manual therapy works not by mechanically altering muscle, facia, posture, etc., but by influencing the nervous system.

Modern pain science has found that the more the nervous system is subjected to nociception, the more sensitive it becomes. Therefore, we avoid creating pain.

When people say, “I have TMJ,” they usually mean that they have temporomandibular joint dysfunction, a condition that can cause jaw pain that can be difficult to treat. Chewing may be painful and it can lead to headaches and neck, shoulder, and upper back pain. They may experience popping, clicking, and shifting when they open and close their jaw and their mouth may even get stuck in an open position if they yawn or open their mouth too far.

"Did you hear about the study of the MRIs and herniated discs?" It was 1995, I was working at St. Mary's Hospital, and one of my fellow massage therapists had news about a surprising piece of research. In those days before the internet it was difficult for us to get information about studies of interest to us massage therapists. A juicy tidbit like this was cause for excitement.

 If all you have is a hammer, everything looks like a nail.

There are many modalities in the field of manual therapy. All of them sometimes work yet many of their explanations contradict each other. 

A massage therapist is trained to treat trigger points. When a client comes to them seeking relief for a pain problem, the therapist will look for trigger points, will inevitably find them, and attempt to resolve them. The client often feels some relief after the treatment. Both client and therapist conclude that the pain was a result of trigger points and that the trigger points have been resolved, at least temporarily.

Another therapist is trained in myofascial release. A client comes seeking relief from pain. The therapist will look for and inevitably find fascial restrictions. The client may feel better at the end of the session, may even find long-lasting relief. Both assume that the pain was the result of fascial restrictions that have now been properly treated and resolved.