Why the word "Tight" isn't an accurate measure of tissue condition

I ran across an excellent article on painscience.com that was written in 2012 about what has to be the most popular phrase in massage therapy. I thought I'd share what I got out of the article and how it has effected my approach as a massage therapist. If you guys ever have any questions, thoughts, feedback, let me know, we are all in this together.

I hear very often from clients and even from other therapists saying "Wow you're really tight!" Or, "am I really tight?!" Or, "can you feel how tight I am??" ...the thing is, that word is very subjective, and it's not an accurate measure of pain or that there's an actual physio problem at all. I've came across many occasions where people swore they're back is very tight, and to me, it felt like a standard soft muscle texture. At the same time, I have also come across people where their hamstrings have a hard, high tonicity texture, like a snare drum, but the client doesn't feel any stiffness or any pain in the area.

I've had instances where clients have said, "my (a healthcare professional) said i am really tight, do you feel it?" And if I don't, i have been saying "it feels a little dense" or "no i don't, it feels normal to me." With that, I wouldn't doubt if people thought I wasn't experienced enough, or it turned down my credibility. In the beginning, I thought maybe it was my lack of experience that was keeping me from being able to discern the difference between tight and not tight muscles. But now, with all the research and reading I do, I now know that my gut was correct, "being tight" is most certainly a feeling, and feelings don't always match up with reality. I've seen plenty of people say they feel tight in their shoulder, yet have great range of motion. The article provides a link to a 2012 study that showed evidence that therapists can't "reliably detect the painful side of low back or neck pain by feel alone".

So if being "tight" is a subjective term, then why do therapists keep saying that? I think they say it because that's the thing for therapists to say, it's expected by the public. Second, I think many therapists feel we all have tension we could rid of, so it's a solid go-to statement, like "we all should exercise regularly" for example. I also think that they feel it adds credibility if they're supposedly noticing something that the client did not. On the other end, I think therapists say that/agree with the client because they are scared of losing credibility. I also think it's still being used because it's an easy sales pitch. Lastly, I also believe it's still being used because this word was said during school, and teachers used it, so it was just carried on into their career.

"In general, massage therapists are prone to fantasies that they can feel things that ordinary mortals cannot, and zero in on tissue problems with uncanny accuracy" (Paul Ingraham)...lol ..i have been told "yep! Thats it! how did you know?" I know because it's a very common spot for people to have discomfort, soreness and pain. I also have a good idea based on the communication of the client, and also because at times I can relate to the situation, not because of a higher enlightening, 6th sense-like ability. However, what I may feel doesn't always match up to what the client says and vice versa. So, I do believe communication and acknowledging what the client feels is important. Who am I to tell people that they are wrong in what they feel? I do agree that massage therapists do have great skill in dealing with soft tissue, and can notice changes, just like a Chef can identify all the ingredients used in a dish in a blind tasting. However, I am really against making up problems and issues in order to keep them coming back.

 

"So, palpation is part of how I assess but not the only thing I rely on." - Alice Sanvito, LMT, St. Louis, Missouri

 

Sources:

https://www.painscience.com/articles/youre-really-tight.php

https://www.painscience.com/articles/stiffness-and-rom.php

https://www.bettermovement.org/blog/2015/why-do-muscles-feel-tight

Tanya Crooks

ThumbWorks Sports Massage, 1224 Mangrove Avenue, Chico, CA, 95926