Treatment Guidelines for Massage Therapists #1: Trial and Error

from — good guide to trigger points

(this is part one of a series… please also check out part two)

If we look at medicine honestly, we see it’s based on trial and error. Even when the board-certified specialist prescribes a drug that’s been studied for decades, she won’t know how it affects one particular patient.

We often don’t know why a treatment works, we just hope that it will.

As therapists, we should be well aware of how hard it is to really determine cause and effect, and how much our own brains trick us into seeing causality where there is none.

No matter how great our palpation skills, how finely tuned our hands. We can’t know whether the “knot” is just a tight spot after sleeping in a hotel bed or whether the hypertension is protecting a small injury. Go after the former with your neuromuscular skills and yay! problem solved. Try the same on injured tissue, and you make everything worse.

So should we just admit to clients that we don’t know what’s wrong, and we can’t be sure whether we’ll be able to help?


As massage therapists, we’re not allowed to diagnose anyway. As patients, we’re all sick and tired of cocky diagnoses that turn out to be completely wrong. Our clients come to us often after being misdiagnosed several times. They don’t need us to point to trigger point charts while mumbling in Latin.

They don’t need the arrogant massage therapist saying that the “arthritis” diagnosis was wrong, and that it’s all just referring pain from a trigger point in the supraspinatus.
Just like the “arthritis” diagnosis, it’s just a theory, and for arthritis there are tests–for the trigger point hypothesis there’s nothing.
Now, if you treat the trigger point, and the symptoms disappear, it’s all good. Points for you!
But what if you treat the trigger point and the problem gets worse? What are you going to say to the confused client who is telling you how badly that shoulder is throbbing? You better fess up and say “I’m so sorry, I must have been wrong about my trigger point theory.” Please don’t go the way of “That’s a good sign, we clearly see a change! That shows it worked!”
Unfortunately most clients would not call you. They just would not ever come back to you, and maybe would never get a massage again.
The cocky therapist might think “That client didn’t come back, so I fixed it in one session–yay me!”.
My suggestions for truthful therapy:
  • Tell your clients what you think about their pain, but make it clear that it’s a theory, you can’t know what exactly is happening in the tissue.
  • Just do a short tryout treatment as the first session. Approach the problem how it makes the most sense to you, explain why, and say openly “Now, if this responds like in similar cases I’ve had, you should feel much better tomorrow, you might just be a little sore, but that should pass by the next day.  Please let me know how you’re feeling, and we’ll make a plan from there.”
  • In the next session you can build on the results–if the tryout helped, do similar work, but make it a full session. Otherwise find a different approach. For example lymphatic drainage can help with healing an injury without irritating the inflamed tissue any further.
Offering “Consultation &Tryout” appointments has been a huge success for me. The reduced rate is helpful for skeptics who are scared of wasting their money, and the short treatment is not as risky as a full session.
I often say: “This is a tryout for you, so you get to know me and my style of work, and hopefully it will already give you some relief. But it’s also a tryout for me, because I see how your body responds to treatment.”
What do you think? Therapists, are you ever worried about looking ignorant  when you’re not sure what the cause of a client’s pain is?
Clients, have you ever felt worse after a massage session?
Please tell your story in the comments!

7 thoughts on “Treatment Guidelines for Massage Therapists #1: Trial and Error

  1. Lu, I want to applaud you for the post. I don’t find it controversial at all, but will say this is my pet peeve among therapists. I have my own story to tell of bone tumor INSIDE my fibula requiring surgery/bone graft that a therapist once just knew must have been tendonitis of my overused ankle area from running. Probably delayed my diagnosis by a few months. Good thing it wasn’t rapidly advancing bone cancer. This personal experience has caused me to be always aware of the vast array of medial issues that could lurk from the pain our clients are presenting with. I had a relative die at age 52 of a rapidly advancing brain tumor (from diagnosis to death was 4 months) and her only symptom prior to the actual diagnosis which was done in the ER with a severe migraine as the only symptom, was in fact, previous headaches. However, she had been having headaches for probably a year. One must hope that if a massage client comes to us complaining of headaches, that we will not pretend to be Jesus with our hands and will actually encourage them that they may want to rule out problems with their eyesight, their dental condition (are their crowns level? etc) and will see their own family doctor to make sure further inquiry isn’t suggested. My relative’s case may possibly have been operable if caught a bit earlier. One of the reasons we receive the bit of training we do is to have the sense to know when to refer clients for their own safety, not just to learn how to give a massage.

  2. Pingback: Treatment Guidelines for Massage Therapists #2: Work the Attachments « Lu Mueller-Kaul

  3. Pingback: Treatment Guidelines for Massage Therapists #3: The Confidence Cure « Lu Mueller-Kaul

  4. Lu, I agree agree with all the content you wrote and give my thanks to your fortitude in saying it publically. My only request is that you change 1 word: in the first paragraph, Change effect to affect. This is an oh-so-common usage error, but the meanings are actually different.

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