Reader response: Hey, I just bought a TENs unit for backpain. Can you give me more information about the safety and what you use? I have unbearable menstrual pain but cant take bc, and end up missing work for 2-3 days because of it.

For those who don’t know, TENS units (short for Transcutaneous electrical nerve stimulation) are little zappy things that stimulate your muscles. After they’ve been stimulated for a while, muscles automatically relax as part of the body’s effort to recover from the recent exertion. TENS units do that artificially via electrodes, which is why chiropractors, PTs, and massage therapists use them to help an overly-hypertonic or spasmed muscle to relax. I only bought my TENS unit recently. This is the model that I purchased from Amazon for about $30, which has several different settings and a dial on top to turn the voltage up or down, along with a manual that tells you how to use it safely. It requires a 9-volt battery, so while you can hurt yourself using it, you can’t do all that much damage even if you crank it up all the way; still, the smaller the area of the body that you’re applying the stimulation to, the lower the voltage you want to use. If you’re applying it to your trunk, like your lower back, you can maybe go up to a 3; on your hand, a 1. The trick is to start low and slowly crank up the voltage until you hit the spot you want to be at.

The best way to use a TENS unit, in my experience, is to put one electrode near one end of a muscle and the other at the other end. That way the current runs down the whole length of the muscle. Obviously, however, this depends on you knowing or being able to figure out the anatomical position of a muscle’s origin and insertion points.

So really, the layman’s best bet of using a TENS unit is to slap the electrodes on the general area that hurts (don’t let them touch each other!) and turn it on low. You won’t get the pinpointed stimulation of the muscles that will help you most, but it’ll still relax the general area, and it feels good, too. Sorta like a vibration.

I can’t speak to using it for menstrual pain, so I do encourage you to seek out additional resources before you give that a shot.

I hope this helped!

Reader Response: As a massage therapist, could you give a rundown on what you would recommend for a client? What exactly are the benefits of Thai vs shiatsu vs deep tissue?

Well, first off: Thai and shiatsu are both deep tissue massage. All that “deep tissue” means is that it’s having an effect on the deeper tissues of the body beyond the initial layer of skin, connective tissue, and maybe the top layer of muscles. There are LOTS of muscle layers in the body–at any one point in the body there are maybe 3-7 muscle groups lying on top of one another. The abdominals, for instance, are actually four layers deep (transverse abdominus at the bottom, internal oblique, rectus abdominus [the 6-pack muscle], and the external oblique on top). Lighter-pressure massage like Swedish or myofascial release tend to focus on the top layer of tissue to improve circulation, release connective tissue, and promote relaxation. The “deep tissue massage” that you’re probably most familiar with is a combination of Western techniques: long gliding strokes from Swedish, pinpoint pressure on “knots” as in Trigger Point therapy, and probably some cross-fiber friction. Depending on the therapist’s training they might incorporate a whole bunch of different stuff from different modalities, but usually when a Western person talks about “deep tissue massage,” they’re describing a combo of Western techniques that have become the definition of that type of massage b/c that’s what people in the West are most familiar with.

Thai incorporates different yoga poses, use of hands and feet, and static pressure to perform deep tissue massage. There’s a ton of stretching, pressure on certain blood vessels to cause a vascular flush, and acupressure points (same as acupuncture except w/o the needles). Different people will get different things out of different modalities; but personally, Thai is great for my hips. I have a lot of scar tissue bound up over my sacrum due to falling on my tailbone when I was a young teen, and something about the pressure and stretch of Thai always helps that tissue release. As a therapist I’d recommend Thai for anyone with low back or hip issues, or joint issues in general.

Shiatsu uses static pressure with the fingers at particular acupressure points throughout the body to move energy (or “chi”) along certain channels (called “meridians”). Again, very similar to acupuncture except without the needles. There are particular patterns that the therapist works with; usually, they perform a thorough diagnosis first to assess the patient’s overall health…and I do mean thorough. Shiatsu follows the Traditional Chinese Medicine (TCM) system, and any TCM modality tends to take the patient’s whole scene into account: their physical, mental, emotional, and spiritual states can affect the treatment protocol. Because Shiatsu uses static pressure, it’s a great style of massage for people with heart issues, while other modalities can be deadly. Someone with heart failure, for instance, could actually be killed by having a Swedish massage. I’m going to repeat that: if you have heart issues, do NOT get a Swedish massage. Swedish is the #1 best massage to improve the circulatory system, and improved circulation can quickly overload a damaged heart. If you’ve got heart issues, Shiatsu is about the only thing you can do in terms of massage. (Same with blood clots. If you’ve got a thrombosis of any kind, do not get circulatory massage: the therapist can actually knock the clot loose and send it through the bloodstream to the brain, heart, or lungs, killing the patient.)

Any other modalities that you’re interested in knowing more about? There are hundreds! Personally, I perform Western-style deep tissue, myofascial release, Swedish, Ashiatsu, aromatherapy, and Tui-Na.

Reader Response: Any suggestions on how to find a good massage therapist in a big city?

That depends on what your primary issue is. If you’re super-stressed out and need to relax, maybe go for a spa environment where everything is designed to be soothing and comforting–though watch out, they’ll probably try to sell you products while you’re there (usually they get paid by commission). If spa prices are too much for you, getting a standard Swedish relaxation massage (which most every massage therapist should be able to do) will help your nervous system settle down. If you’re looking for a more therapeutic massage, then things get more interesting. Any massage place should have a bio of the therapist on their website; if they don’t, then call the place up and ask them what techniques and modalities the therapist specializes in.

Got a history of surgery and joint replacements? Go with someone who mentions MFR (myofasical release) in their bio.

Got a bunch of muscles knots? TP (trigger point), Tui-Na, Shiatsu, Trager, and sports massage are all fitting choices.

Low back pain, muscles feeling bunched up? Thai‘s a good bet.

Terrible headaches or jaw issues? Craniosacral.

Swelling or lymphedema following cancer treatment? MLD (manual lymph drainage) or lymphatic massage.

Overall energetic imbalance, where you just feel blah? Tui-Na, Shiatsu, Reiki, tuning…there’s really a bunch of different types of energy work.

I’d suggest looking for a therapist with at least a year of experience. There’s a certain level of skill that you can really only achieve from having your hands on a lot of different bodies.

I hope that helps! If you have further questions about a specific ailment, please don’t hesitate to contact me. (And the same goes for everyone else.) And, if you’re in the Portland, OR area, I know a great massage therapist. *raises hand* :D

Reader Response: This is a bit of an odd question, but here goes: I have a gift certificate for a massage. Is it polite to tip the massage therapist, like you would a beautician or a manicurist? If so, is it the same going rate of like 20%?

Not an odd question at all, I’m glad you asked! Tipping massage therapists (and how much you tip) can vary depending on the situation. If you see a massage therapist at a chain–like Elements Therapeutic Massage, Massage Envy, or the like–then the therapist is actually getting very little of the price of the massage, so a tip is somewhat expected…and counted on. I used to work at a massage chain and there, tips were 1/3rd of my income. As for how much…15-20% is customary. I usually get a $10 tip for every hour of massage (so 1 hour = $10, 90 minutes = $15, 2 hours = $20).

No, I have a private practice. There, I do not expect or count on tips at all. If I get them, great; if not, no biggie, because I’m getting a MUCH bigger cut of the massage price (minus overhead). The same goes for therapists working at a chiropractic or acupuncturist office.

I hope that answered your question, and that you enjoy your massage! If you have any further questions about massage therapy, or if anyone else out there does, please don’t hesitate to ask; just hit the "Contact" link on the top menu bar.

Reader answer: Would you mind if I asked what has surprised you about massage or the human body, or say what are some interesting things you have learned/wish people knew?

The thing I wish people knew is that massage does not have to hurt in order to be deep tissue/therapeutic massage. Seriously. “Deep tissue” refers to the fact that there are tons of muscles layers in pretty much every part of the body, overlaid on top of one another like rings in an onion; sometimes the issue that’s causing pain is in the top layer but more often it’s a few layers down or even at the bottom. In order to reach that layer, a massage therapist has to find ways to work through the upper layer(s). Now, a lot of therapists are trying to rush b/c their clients want a full body massage in an hour plus focus work in the area that’s bugging them most. So they press really, really hard. That’s one way of getting to the bottom layers, but it causes some bruising and pain to the upper layers.

A far gentler and more effective method is to relax the top layers of muscle then work your way down. Think of is in terms of an archaeologist’s slow, meticulous, careful excavation versus the jackhammer of a construction crew. The former is far less painful, more beneficial, but takes longer. You can’t do the archaeologist method if you’ve got one hour to massage a client’s whole body.

Add to that, people who have had deep tissue massage before think that it has to hurt in order to be effective, because they’re so accustomed to the jackhammer method. Thus, I’ve encountered clients who won’t tell me that I’m causing them pain because they think that’s what I have to do in order to be effective and actually treat their issues, and a lot of the time I don’t. I’ve had clients outright lie and say that the pressure level/technique that I’m using doesn’t hurt, and then when I go to turn them over I realize that they’ve soaked through the sheets with sweat.

So please: don’t let your massage therapist cause you pain. If you’ve got a major physical issue that you need work on, tell them you want “focus work” in that specific area, and tell them which body parts they can skip (i.e. you don’t care about having your hands worked on, or your legs feel pretty good today, etc.). A lot of the time things are connected, and an issue in the back may actually be caused by something in the abdomen or hips; but it’s virtually impossible to do a deep tissue massage on the whole body without causing a lot of pain and bruising. Focus work lets us strategically and carefully hit the areas that are causing the issue instead of whipping out a jackhammer.

Also, don’t go to Massage Envy, they have a history of hiring sexual predators. There’s a reason they’re so cheap: I know plenty of good people who work there, folks I went to school with, but overall the company does not have quality control for who they hire and they apparently don’t even communicate in between franchises. This one time in Texas, a male therapist sexually assaulted a female client at one Massage Envy, got fired, and six months later was re-hired at a different Massage Envy a few miles away where he sexually assaulted another female client. So. There’s that.