FAQ: Why is tension carried in the shoulders?

Many of us seem to carry tension in the shoulders as if the whole world rests on our shoulders.  That’s right.  We often feel like it, with so many responsibilities, urgent tasks, and uncertainty for the future.  But, why in the shoulders?

It seems the main cause is mechanical – poor posture.  Most of us spend too much time sitting with the head forward or down and the hunched back.  Since we keep the same position for a long time, the muscles in the upper back are stretched out while the chest and abdominal muscles are short and tight.  Both stretched-out and short muscles cause problems.

From the perspective of body-mind connection, muscle tension and nervous tension are hand in hand.  Mental stress triggers the muscle tension, and the muscle tension causes discomfort leading to stress.  It goes both ways and is a vicious cycle.  Some degree of muscle tension or nervous tension is normal and even necessary.  However, if it’s happening constantly and becoming a habit, it will do more harm than good. 

When we are anxious, worried, upset, or distressed, we experience faster and shallower breathing as well as other fight-and-flight responses.  We sometimes hold our breath.  Thus, the chest has to work rather than the diaphragm,  a large muscle below the lungs to control breathing (read more about the diaphragm in this post).  To move the chest up, the muscles attached between the neck and the ribs or shoulder blades have to do more work.  If the condition persists, the shoulders stay tensed up. 

A small step to reduce shoulder and neck tension is to catch ourselves in the poor posture and under stress/anxiety.   Do the exercise for upper body, and breathe slowly from your stomach (read the next post about breathing exercises).  And, get a massage to relax!  We deserve a break from carrying the world. 

FAQ: What is the “Right” Pressure?

Massage therapists ask you about the pressure during a session.  However, if you are still new in massage, you might not know exactly what the “right” pressure should be.  As I wrote in “FAQ: No Pain, No Gain,” some people believe that a massage should give them “good pain,” so to speak, to be effective.  It shouldn’t.

You might think massage therapists should know what pressure is right for you.  Yes, and no.  They do have a good idea based on how your tissue feels like, so they can adjust their pressure accordingly.  However, how your tissue feels like (e.g. tightness) isn’t always a good indication because it is you, who feel it, not your tissue.  You can be very sensitive to touch and can’t stand any deep pressure even if you have tight muscles.  On the other hand, your tissue isn’t tight, but you feel it tense and want stronger pressure.  The perception is relative.  

Another issue is the approach of each massage therapist varies as I mentioned in “Art of Pressure” and “FAQ: Is Deep Tissue Massage painful?”  On top of that, what each of them expects their clients to feel is also different.  I understand that you trust your therapist’s judgment and go along with “not-so-sure-feeling” believing it might do you good in the end.  Or, you just thought that’s what was supposed to feel like. 

I have an embarrassing story when I received a “deep tissue” massage after I became a massage therapist.  The massage was vigorous all the way through, and the pressure was strong, but I thought it was not hurting, and I couldn’t bring myself to tell the therapist to lighten up.  I thought she should know what she was doing.  The outcome was miserable.  I felt “energized” right after the session, but then my body started to get sore everywhere and got even a bruise on that day.  I ended up with pain that I didn’t even have.  I realized our definitions of a “deep tissue” massage were completely different.

You, as a client, should be in charge of what feels right for you.  Trust your “first perception.” (In my case, the pressure was “strong.”)  I remembered that one of the instructors at my massage school said “if you are thinking about pressure during the session, it is probably too much.”  

FAQ: Why Massage Makes Us Feel Good?

Touch is the most important foundation of massage therapy.  I have written about how touch affects body and mind in “Touch,” “Benefits of Massage,” “Human Touch” and the Japanese post “スキンシップで幸せになろう.”  Now that recent studies prove that touch is good for us, I will sum it up from a scientific point of view. 

When we receive positive touch, two (at least) physiological reactions happen to us.  First, the parasympathetic nervous system is activated.  The parasympathetic nervous system is our home base and helps us back to healing mode, “rest-and-digest,” decreasing the “fight-or-flight” stress response.  Consequently, we experience the sense of relaxation and contentment.

Secondly, oxytocin, so called the “love hormone,” made in the hypothalamus in the brain, is released.  It immediately makes us feel calm and connected to the environment and people around us.  It contributes to relaxation, healing, trust-building, and psychological stability.  One of the studies on oxytocin and massage concluded that “massage increases OT (oxytocin) and decreases ACTH (adrenocorticotropin hormone)”  (ACTH is a hormone often produced in response to emotional and physical stress.)

We don’t have to have pain or tight muscles to receive a massage.  Without knowing it, we deal with stress (big or small) all the time or are getting ready for the next stressful moment.  Massage gives us a break.  Let’s make a feel-good-experience a habit to better our life.

FAQ: How to Relax

As a matter of fact, receiving massage is a skill to be learned.  I don’t assume that everybody can relax and let go of their body.  One client who was receiving a massage for the first time asked me what he was supposed to be doing on the table; if he should get his body floppy or tense to benefit from massage.  I thought that was a great question.  There are techniques that you actively participate in moving, stretching, or resisting.  Other than that, you let your body relaxed to benefit from massage.   

A part of the goal of receiving massage, I believe, is to let go of the body and mind.  Some people are aware of not being able to relax, and others don’t notice that they are tense.  Or, some just try to help me move their arms or neck.  Whatever the relaxation level is, I am happy for you to be receiving massage.  Because, relaxing your body is same as quieting your mind.

Here are some of my personal tricks which might help you.

• Imagine you are floating in the water.  Feel your body synchronizing with the movement of the water.  Your whole body must be completely let go.  Otherwise, you will sink.  
• Let the teeth apart and relax the jaws.  You tend to keep tension in the facial muscles.  Once your jaws get soft, other parts of the body will follow the suit.
• Feel the sensation of your body, but don’t analyze it.  You can stop having thoughts (even momentarily) and be present with yourself.     
• Focus on breathing as you might have heard too often.  Feel the sensation and movement of the chest.

Good luck!

FAQ: Does a massage therapist tell me what’s “wrong” with me, and “fix” my problem?

Massage therapists are NOT allowed to diagnose any conditions.  Although more and more massage therapists work in clinical settings, they can only assess the condition, apply “the manipulation of the soft tissues” appropriate for the condition, and possibly suggest self-care you can do at home (the scope of practice varies by state).  Massage therapists cannot say and shouldn’t imply that you have “carpal tunnel syndrome,” for example. 

Some comments from people and even other massage therapists have caught my attention.  It is getting obvious to me that we were taught somewhere that we are “bad” if we have pain, knots, stiffness, or any other soft tissue problems.  It seems to be treated as a disease.  We even label the shoulder or any part of the body which gives us troubles, as “the bad shoulder.”

I understand you can’t help asking this question: “Do I have a knot there?”  It is a natural desire to know the cause of the issue because it’s supposed to be “bad” and should be treated.  Some people take it almost personally, but get relieved to know that many other people have the same problem.  Others seem to give in to the fact as “I-have-lots-of-knots-in-the-shoulder-you-will-see” and are even apologetic as if they did something wrong.    

I started to wonder if massage therapists are the ones educating their clients that they have “bad” knots or “bad” shoulders, so the therapists have to “fix” them.  I was taken aback when one lady told me that her massage therapist vulgarly said her body was “messed up (not the exact word),” so she “had to fix her.”  I wonder if playing a doctor really makes anybody feel better and positive about their body and themselves. 

I believe any massage therapists intend to help their clients feel better.  It’s just that my approach is different (A Holistic Approach explains how my view changed).  First of all, I do not judge no matter how the condition is, by tightness, the numbers of knots and etc.  I accept as it is.  I only feel for them for their discomfort and frustration.  Secondly, I try to use only positive expressions, and avoid negative words, especially “bad.”  I want each of my session a positive experience.  Human body has the innate power to heal itself to maintain equilibrium called “homeostasis.”  As I always emphasize, the body and mind are strongly connected.  My goal is to offer them confidence that they are in charge of their body and can go through a positive change.  I am only here to help, not to “fix.”  

FAQ: Is Deep Tissue Massage painful?

Some people want to get Swedish Massage to relax, and some love Deep Tissue Massage to feel that their body is surely worked on.  Whatever you choose, all massage is “therapeutic” in the sense that massage influences and promotes your well-being.  

Deep Tissue Massage (I call it Connective Tissue Therapy) seems to be regarded as a somewhat painful method opposed to Swedish Massage.  However, the Connective Tissue Therapy I learned is not intended to push hard or cause pain.  As I explained about fascia and the cornstarch experiment in the previous post “Fascia (Connective Tissue),” I sink in to the tissue slowly only to the degree that the tissue allows me (read about my techniques).  It may not turn out to be “deep” depending on the condition of the tissue, but it is all effective as the superficial fascia still has an effect on the deep fascia.  The work is intended to allow the restricted or dehydrated fascia to become softer and more supple.  The Connective Tissue Therapy invites you to be aware of your body and provides a unique opportunity to discover yourself.  You could experience deeper relaxation because of the slower pace.

Ask your massage therapist first what their “Deep Tissue Massage” is like.  Since massage techniques, methods, and approaches are not clearly defined unless they are registered such as Rolfing®, “Deep Tissue Massage” can be quite different depending on the therapist.  And also, it may be called “Connective Tissue Massage/Therapy,” ”Myofascial Massage,” or something else.  It's important to find one you like, whatever is called.

If you like Deep Tissue Massage, read "No Pain, No Gain?"

FAQ: No Pain, No Gain?

“No pain, no gain” is the phrase most frequently heard from clients.  I also believed it, and I liked deep tissue massage before going to massage school.  The first challenging idea for me at school was “A massage doesn’t have to hurt.”  I also explained other changes while at school in the post “A Holistic Approach.”

I found many websites by massage therapists that “No pain, no gain” is a myth, and others express some pain is necessary.  I agree with the latter because it really depends on the condition and the goal of a massage.  If a massage is for a rehabilitation purpose, the pain is not required to get better.  However, if the pain is caused by trigger points, it is necessary to feel the pain especially in the beginning.  Even if treated on trigger points, the pain level shouldn’t exceed the client’s pain threshold.  Tracking the client’s non-verbal cues such as frowning, flickering, and clenching is very important for the therapist.  In addition, the therapist should respect the tissue and know how deep, how fast and how much pressure the tissue can withstand. 

Some of you have high tolerance for pain and also believe “No pain, no gain,” so even if it’s uncomfortably painful, you may not tell your therapist.  If you are not sure about how much pain is reasonable, check to see if you can keep breathing normally.  If your breathing stops frequently, I would guess you are enduring the pain too much.  If you can’t relax, your muscles keep contracted and tight, so a painful massage may not help the condition.  Another guideline can be a pain level of 7 or less on a scale of 1 (no pain) to 10 (unbearable).

Again, it really depends on your condition and the goal of your massage, so good communication between you and your therapist before and during the session is very important.  Don’t stick to “No pain, no gain”!

FAQ: Does a massage therapist work on my buttocks?

When my clients have a lower back problem, I always work on their buttocks; gluteal muscles.  The area is very important to be addressed because there are many trigger points to relieve pain in the low back, hip, and thigh, piriformis syndrome (the symptoms similar to sciatica), and numbness in the leg.  Good massage therapists know the benefits of gluteal work and aren’t hesitant to work in the area.  I strongly recommend your buttocks be worked on if you have problems mentioned above.  I work on the area over the sheets if a client wears underwear.  I can’t apply smooth gliding strokes, but I can use compressions and other techniques, which are as effective as ones directly on the body.  However, if I work on the tissue directly, I would be able to feel the trigger points and adhesions more accurately, and the strokes would feel smoother to you. 

Here is an example video of how a massage therapist works on the buttocks area.  It's long and technical, so you can fast-forward it.  I don't do exactly the same way, but this will give you a general idea of how a massage is done. 

The important thing for you is to be comfortable and make the most out of your massage session.  Don’t feel pressured to agree on what you don’t feel like.  If your therapist is good, they never insist on their own agendas. 

FAQ: Should I take off my underwear?

This is probably the first question you may have before you get a massage for the first time.  I always tell my clients to undress to their level of comfort.  This means, if you are not comfortable taking off your bras, you can leave them on.  Massage sessions are for your comfort, which is more important for your relaxation than my convenience.  I can work around any garments left on.  I have worked on a lady with a tank top or undershirt.    

It is true, however, without undershirt or bras on, I can apply smooth, continuous gliding strokes to the body, which would feel more relaxing, if you are comfortable.  I get permission from clients to unhook the bras only when I work on the back, and put them back.  However, if you are not comfortable with this request, you should say no.  

Regarding underpants, I don’t mind if they are on or not.  Male clients tend to keep them on maybe because they don't want to embarrass me, but I am professional, so I won't be uncomfortable.  If clients wear boxers or briefs, I ask them to pull them up toward the hip bone when I work on their upper legs.  Without underpants on, I can apply continuous strokes up to the top of the thighbone and the buttocks to be able to address low back pain, sciatica, knee pain, and tight quadriceps, hamstrings, and IT bands (a thick band on the side of your thighs).  

When clients, whom I have seen some time, have sciatica or low back pain, and I think it will be more beneficial for them to receive work on their buttocks without underwear, I explain it to them and make sure if it will be totally comfortable for them.  I recommend you try without underpants on next time if you are completely comfortable with the idea.  

You might also want to read the related post "FAQ: Does a massage therapist work on my buttocks?" and watch the video. 

FYI - Draping is required in the state of Florida, so even if you are without underwear, the gluteal (buttock) cleft must be covered all the time, and only one side of the buttocks is undraped at a time.