Table Talk: Macho Dos

Bear  painting by Phillip Hoyle

     Clients often do not want to tell their therapist about the pain they are experiencing in the massage, and when they do, their communications are sometimes hard to interpret. It took me quite a few massages to understand that when Richard laughs, I’m hurting him. With Tom, silence means all is well, but moans indicate pain. Some people scream or say “No,” but more folks seem to grit their teeth and bear the pain in silence. I imagine that they lie there chanting over and over to themselves, “No pain; no gain. No pain; no gain....”

     One evening Sergio called. “Can you work on my brother-in-law?” he asked. “He fell at work and hurt his leg.”

     “Sure, but you come with him because I’ll need a translator,” I replied.

     Juan, Sergio’s brother-in-law from Mexico, had fallen off a ladder while painting a house. His facial expression and his noticeable limp while climbing the stairway indicated that he was in a great deal of pain. I examined his leg, compared it with the other. There was no bruise or significant swelling, but Juan winced at my touch. I began working in Swedish mode, knowing I would apply deeper pressure to his injured leg if he could bear it. I warmed up the tissue near the injury employing a variety of strokes and explained, while Sergio translated, what I hoped to do. Since I would have to work deeply, I taught a monitoring system so the work wouldn’t cause unnecessary pain. I asked Juan to respond to my inquiries with a number on a scale from one to ten. One, uno, indicates pressure with no pain; ten, diez, indicates way too much pain, “get out of there now.” My training considers numbers between four and seven to be therapeutic. As I worked, I asked periodically, “¿Que numero?”

     Juan answered, “Uno.” Again he replied, “Uno.” Still again, “Uno.” 

     I was a bit surprised at his tolerance for the pain. As I began working right at the point of injury I asked, “¿Que numero?”

     With a ragged voice he barely croaked, “Dos.”

     “Oh,” I exclaimed, laughing gently, “¡Macho dos!”

     Sergio almost fell off his chair in a fit of laughter. An embarrassed Juan amended his numero. “Ocho,” he admitted. I lightened my touch slightly to lower the pain level and continued to work, but I wondered whether I would ever know how much this work hurt my client.

     My colleague and friend Tony gave me a massage. He worked deeply, but I didn’t feel pain as his elbow hooked into my lower trapezium muscle and then as it bumped over my rhomboid minor muscle. I was surprised since this move often causes a high level of pain in my clients. Why the difference? I’m not quite sure, but some of my clients, like myself, don’t feel much pain at all. Other people, like Juan, bear high levels of pain out of some notion of self-image.

     Still others feel intense pain but really seem to like it. I realized one client had grabbed onto the legs of the massage table and was hanging on as if for dear life while bearing extreme pain. He seemed to love the pain I didn’t intend to give. When I noticed his grasping of the table, I lightened my pressure. Another client told me, after our second deep tissue session, “Phil, I’m really starting to like the pain.”

     I hope he was only kidding. My intention is to reduce pain. I don’t like to cause my clients discomfort, but I am capable of it and not unwilling to do so when I believe the painful work may actually prove beneficial. The big problem is that similar pressure doesn’t feel the same to different clients. The client must monitor the pain since one person feels uncomfortable, another one is in unbearable agony, and still another one is not registering any pain at all.

     In general, I want my clients to become more aware of their pain so they can do things to prevent or relieve it. Sometimes they can correct their posture, learn relaxation, and otherwise help themselves. I want them to learn self-treatment--how to massage themselves and how stretch their muscles. To accomplish such goals, the client and the therapist must work as a team, cooperating and communicating. I want them to think about themselves in order to discover what they can do to lessen their own pain, both during the session and in the weeks that follow it.

     Juan was in pain. I didn’t want to cause him more. My goal was to get the muscles out of spasm and to increase circulation in them so they could heal more readily. I hoped to lower pain in the area through the treatment of any trigger points that might have formed in the muscles from a prior accident. I was sure the work would cause additional discomfort, but if he would monitor me, I could keep the pain within a therapeutic range. I needed Juan’s help. When he finally gave me realistic responses, I was able to adjust my pressure and work carefully and appropriately in the affected area. Juan helped me, and in so doing, increased the effectiveness of the massage.

Brown and Black
painting by Phillip Hoyle

People of all kinds and sizes and with all kinds of expectations come for massage. Some want pain; others want only the softest touch. Both types of massage can be effective in dealing with pain. I figure whether I'm dealing with a grizzly bear or the gentlest black bear on my table I know I can help them with their pains. Actually I find the factor of the unpredictable in massage keeps me alert. You never know what kind of work will be called for to help your client.