My goal with this session is for the client to stand up from the table feeling ease and freedom in their posture. If they say something like “I feel an inch taller,” I know I did it right.
Why not just “dig out the knot”? Because I don’t think that spot is to blame. This seems to be an area that becomes sensitized when the upper back muscles are in an untenable position: Being required to stay long and strong for hours a day, and generally being overpowered by the pecs. If we can get all the nearby muscles to give up some of their baseline tone (which I think myofascial release is a great choice for), then that gives the client’s nervous system a chance to reevaluate that tug-of-war.
And that brings me to something I’d like to address: Client buy-in. Are you giving the client an idea of your clinical reasoning before you proceed? Are the two of you determining the best course of action together? This has implications for a lot of things that we value as massage therapists: Pain outcomes, rapport building, informed consent, and client return rate.