Am I tight?

Here’s a novel question: ‘Am I tight’? And by novel I mean not novel at all. I hear this question every day, almost everyone asks it. And I have grown weary of it. To answer this question honestly takes a fair amount of effort. But I make the effort because educating my patients is one of my primary goals. I always try to take my time and choose my words wisely. It’s not just a simple yes or no question. The real answer is more complicated.

Most therapists are more than happy to give an affirmative response to this question. Some don’t even wait for the question to be asked and make the declaration without any prompting from the patient. ‘Oh you’re so tight’! This seems like the party line for massage therapists. My profession is not the only one guilty of this. Chiropractors, physios and even doctors are telling patients this. I can think of a couple of reasons why.

Firstly, when people seek out massage they usually feel like something is a little off, like something is wrong. They want their feelings validated, to know something real exists and their therapist can feel it. It’s natural for us to agree with our patients, we want them to like us. We don’t want them thinking we can’t feel what is obvious to them and to every other therapist they’ve encountered.

Secondly, telling people they are tight may also give the impression that they have a condition that can be alleviated by yours truly. ‘You feel tight, but I can fix you’. This is good for business, not always good for the patient. A therapist’s declaration of how tight a patient is has no relevance in the context of treatment.

Every body I have ever laid my hands on is completely different. Peoples’ tissue texture varies as widely as the amount of birds in a tropical rainforest. Some people have hard and ropey tissue, while others are soft and malleable. I’ve encountered people whose bodies are like a bag of cement and others that are like a bag of Jell-O. With some it feels like I could pull the skin and muscle an arm’s length off the bone and with others these tissues feel like they’ve been adhered to the bone with crazy-glue. Some bodies all I can feel is bone and a thin layer of tissue, others it feels I can sink my fingers four centimeters deep and still feel no hint of bone. None of these presentations correlate well with pain.

So with all this variety of tissue quality and with every body presenting in its own unique fashion it’s hard for me to know if what I’m feeling is relevant to the patient. It may feel tight to me, but does it feel tight to the patient? And to what am I comparing this level of tightness? I don’t have a baseline. I can’t just create an average from my last hundred patients. There is no optimum level and no way to measure this anyway. Without these things it seems a little ridiculous for me to claim someone is tight.

In my early years as a therapist I was guilty of this. I told people they were tight. It was easy to do and it made me feel competent. I wanted to be like every other therapist, able to know just where the problem was by placing my hands on a body.

Finding areas that felt tight to me wasn’t a problem. The problem was these spots did not always coincide with what felt bothersome for the patient. I thought maybe it was just my inexperience. But all my fellow therapists had no problem with it. Or at least it seemed that way.

Then along came Paul Ingraham and his ultra-informative website, painscience.com. He introduced to me an intriguing concept called palpatory pareidolia. Pareidolia is defined as ‘a psychological phenomenon involving a stimulus wherein the mind perceives a familiar pattern of something where none exists’. Usually pareidolia refers to optic or auditory illusions, like seeing faces in the clouds or the Virgin Mary on a piece of toast. But this phenomenon can also be experienced through touch.

Basically this means there’s a lot of therapists out there thinking they’re feeling something they’re not. We’re discussing tightness here but I can think of a few other things also. I’m talking about you trigger points, fascial restrictions, adhesions and scar tissue. If you have been told you have fascia needing release or adhesions causing dysfunction, be skeptical.

It’s true that massage therapists are extremely proficient in detecting muscle and tissue texture. But when we try to attach meaning to what we are feeling it becomes a little precarious. Telling patients they have some sort of dysfunction with their tissue, or even alluding to it, can end up being a big nocebo. We don’t want people leaving us feeling defective or flawed.

Our ability to detect what is painful with just our hands is deficient. Sure, most of us have the ability to zero in on the exact spot of discomfort. But this is not because we have magic hands. We couldn’t do this without guidance from the patient. This can come from subtle cues like the breath and body language, or some not so subtle like when the patient groans as the right spot is found.

There are still plenty of things we don’t know about the body but we know this: a person can feel as tight as a boa constrictor choking its prey and yet feel no pain. Conversely a person can feel looser than Gumby in a sauna but feel constant pain.

There is just NO CORRELATION between how tight you feel to a therapist and your level of pain.

So the next time your massage therapist tells you you’re tight remember these things: your therapist says this to everyone, there’s no optimum level of tightness, and tactile illusions are real.