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.

There are a few ways this can go. The easiest option is to be bowled over by the client’s requests and keep your ideas about pain and the body to yourself. “Well, I guess I’d better get to frictioning this spot for a full ten minutes, because that’s what the client wants.” This is a good way of getting pushed past your physical limits and feeling like you’re giving someone else’s massage. It can also lead to worse outcomes! The client might be satisfied — sustained intense stimulus can result in temporary desensitization — but this seems like a sure path to rebounding pain.

Another option: Skipping past the client’s ideas about the body and doing what you think is best. “I know that the pain comes from somewhere else, so why would I touch that spot?” This can be exquisitely frustrating for the client (who keeps wondering if you forgot about their request), and I think that it can reduce the effectiveness of your work. We’re not replacing spark plugs or installing a new motherboard, we’re dealing with a whole person. If they don’t think that the work is likely to be effective, then they’re probably right.

So, what am I recommending? Give the client some insight into your reasoning as a massage therapist, and then ask them if they’d like to try your approach. That can sound like this: “In my experience, people with pain in that spot tend to have powerful pecs pulling their shoulders forward, tension around their shoulder blades, as well as tightness in their upper back. Rather than just focusing on that one spot, I’d like to work with all these areas that are involved in that tug-of-war. Does that sound good to you?” From there you can gauge their reaction and decide how to proceed together.

That’s what I mean by “buy-in.” By bringing the client on board with your approach (and altering it based on their feedback), you’re partnering with your client and making them feel like a participant in their own healing. It’s good for rapport, it’s necessary for informed consent, and it leads to better outcomes. It’s a good thing.

I’d love to hear what you think! What do you do when you encounter a client with “that damn spot”? Do you have any tips for bringing clients on board? Let’s talk about it in the comments!