My back hurts but you want to massage my front!?

Many times you'll go to a massage therapist and say "my back hurts here" and get massaged right there.

If you see a therapist trained in clinical thinking, they will acknowledge that it hurts between your shoulder blades, but want to release your pecs; your low back hurts but they're going to massage your core muscles through your abdomen.

This annoys some clients who just want you to grind on that knot between their shoulder blades for an hour. Rightfully so, if the therapist has not engaged them in client education as to why they're massaging the opposite side. Just grinding on that knot may sound great, but it will be unlikely to address the actual problem.

Let's look at a few examples:

Pectoralis Minor attaches to the front of the scapula

The scapula (shoulder blade) is not actually held to your skeletal system as a joint - it's merely held in place by muscles & connective tissue. This makes it highly mobile but also the potential for being held in sub-optimal position by shortened muscles.

Our average daily lives tend to involve too much hunching forward: at computer desks, driving, sleeping... When a muscle is in a shortened position with regularity, the body adapts. Your body says that if you're going to hold me in this position all the time, I'm going to lay down collagen fibers to lock the muscle in place so we don't have to waste energy with constant muscular contraction. The body aims for efficiency.

You know that pesky pain between your shoulder blades? It's often the muscles back there being overstretched & abused. By doing nothing but grinding my elbow into that area, I am likely to irritate the tissue more (stretching an already stretched muscle). By freeing up the chest, it helps allow the scapulae to retract to a more neutral position and relieve stress on that area between the shoulder blades. There are other muscles that play a role in this that don't seem directly connected, but pec minor is a good example and an area that tends to go under the radar.

Iliopsoas, often called Psoas (so-az) for short

Iliopsoas is huge for lower back pain. It's the same basic concept: this muscle is frequently fixed in a shortened position for many, many people. It attached to the pelvis as well as lumbar spine, and when contracted puts the spine into an excessive curve (think of an arched lower back) and contributes to an anterior (forward) tilt of the pelvis. Both these postural positions stress the lower back muscles and potentially nerves as well, causing pain, dysfunction, and negatively affecting postural alignment.

Too often I have heard of sufferers of chronic lower back pain getting massages for years and years without much progress, only to find they've never had their Psoas addressed. This deepest of core muscles can give powerful relief when released, and it's not just for lower back pain. This muscle is huge and has several attachments along the spine and pelvis - this can affect a multitude of areas.

Figuring out the root cause of your pain is important for lasting relief in massage. It's not as simple as the "I hurt here so massage here" approach many people seek. There is benefit in addressing the direct area itself, no doubt, but you have to look at the bigger picture for effective relief.

It's all connected.