Do you dread going to the physio like kids dread going to the dentist? I am asked at least a couple times a week why I don’t always push very hard when mobilising or massaging patients. Funnily enough it is usually the little nonna egging me on to massage/mobilise harder. Now, don’t get me wrong – sometimes it is necessary to put some elbow grease in, usually while the client makes a funny face and curses your name. The default treatment should not be all out torture, however.
So, why do we use different pressures? When seeing a new patient, I have no real idea how irritable their injury/condition may be. By taking a thorough history I will have an idea, but you never truly know until you see how it reacts when you give it a push or a prod. Sometimes you won’t know until the next day, when the patient wakes up very sore if you’ve gone too hard too soon. So it can take a few sessions to feel out what is tolerable for each individual without pushing them over the edge. There is a ‘standard’ grading for joint mobilisations – Grade 1, 2, 3 and 4. In a nutshell, Grade 1 mobilisations are just beginning to move a joint, whereas Grade 4 mobilisations will take a joint through to the limit of its movement or range of motion. With this in mind you can see why a stiff, cranky joint may not appreciate being pushed/stretched to it’s theoretical limit.
There is no real standard of grading for massage / soft tissue therapy – I tend to use the patients ability to stay relatively relaxed, as well as their expression. If they begin to raise a closed fist and aim it at your head, it’s probably time to back off. If you cannot keep mostly relaxed, soft tissue massage can be counter productive. The aim is to loosen up stiff tissue, break up adhesions and scar tissue, and encourage better movement. If you tighten up reflexively due to the pain of a hard massage, you may not be moving in a productive direction.
With all that being said, a physiotherapy treatment will sometimes be uncomfortable. We may need to move a joint through a range of motion it hasn’t experienced in a long time, or loosen up very tight or scarred up tissue. Often we need to see which movements hurt to do, in order to better understand the problem. If something hurts, let us know! Communication between physiotherapist and patient is an important part of recovering quickly. Remember, our aim is to help, not hurt.