Wow, You’re Really Tight

The three most common words in massage therapy are pointless

by Paul Ingraham, Vancouver, Canada MORE
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Credentials and qualifications

I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.

For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.

I’m starting to think that there may be more myths about massage than truths.

“You’re really tight” is doubtless the most predictable statement in massage therapy offices the world over … so what a shame that it’s pretty much meaningless. It took me just a few weeks of clinical experience as a junior massage therapist to notice that tissue texture correlates really poorly — like, um, really not at all — with pain or any other symptoms. Tightness mostly indicates … itself.

People with hard, ropy, muscle texture that you could bounce an axe off of … may have no apparent problems with pain or stiffness.

People with doughy soft muscle texture … may feel incredibly stiff and sore.

Mix and match at will: there is no pattern. Muscle hardness or tightness is simply not constant companion of muscle dysfunction. Whatever commonly makes muscles ache, it produces no clear, reliable objective sign of it in their texture.

For a couple of years I remained open minded to the possibility that I simply didn’t have the experience and skill to detect subtleties of tissue texture, but eventually I settled into my conviction that hard, ropy, “tight” muscle texture means almost nothing.

So why do massage therapists routinely comment on tightness?

It’s mostly just a verbal tic, something to say to pass the time. Tightness doesn’t even actually have a clear meaning.1

But the words “you’re really tight” are also the opening to a sales pitch. The additional phrase “and I can fix it” is tactfully omitted but always implied. It is one of the simplest ways to convince yourself and the patient not only that you have special knowledge of their tissues — a misrepresentation at best — but that you have power over it.

Massage therapists probably do indeed have unusual “knowledge” of soft tissue, but most of it cannot be described: we know muscle like a blindfolded painter can tell you what type of paint you’ve dipped her brush in. We may indeed detect amazingly slight differences in tissue texture, but that doesn’t know that we know what it means, and pretending otherwise is the thin edge of the wedge of arrogance.

In my practice, I absolutely refused to say things that made my knowledge or skill seem “special,” and avoiding “tightness” declarations was the most routine opportunity to be humble. I am not kidding around here: I was conscious of this, and deliberately refused to indulge in this. On the rare occasions when it slipped out, I always hurried to qualified it. Example:

“Wow, your trapezius feel really tight!”

Pause. Think. Hmmm. So?

“Of course, I have no idea what that means, or if I can change it, or if it would matter if I could. But, for the record, they feel pretty bullet-proof!”

Science saves

Finally, along comes a scientific journal to back me up on all this. About time. This brand spanking new experiment from the Journal of Pain says exactly the same thing I’ve been saying all along, just in science-speak:2

This study confirms clinical findings with heterogeniosity in pain sensitivity and hardness across the upper trapezius muscle.

And I particularly liked this:

Two sites [in the trapezius] with low pressure pain thresholds were typical locations for tender points, and these were the least hard sites.

In a dozen people, carefully measured, the most sensitive spots were not just not particularly hard … they were the least hard. Go figure, eh? So, when therapists look for tight or hard spots, then they may very well miss the tissue that is actually the most sensitive. Perhaps your massage therapist should start saying:

Wow, you’re really soft …

Response from a colleague

Other professionals often comment on my articles, but rarely have I received any feedback so perfectly in harmony with my point as this note from Alice Sanvito, a massage therapist from Saint Louis, Missouri. Here is her message in full, adding some excellent thoughts of her own. I particularly like what she learned from dissections:

“You’re really tight” is a phrase that makes me cringe for a number of reasons. I prefer to ask questions, the most common one being, “How does that feel?” After having my hands on people for an estimated minimum of 15,000 hours over almost 20 years, yeah, I can feel some stuff. And often I can’t. I rely both on feedback and palpation. People often wonder, though, how I know exactly where to go without them telling me and I think it’s a combination of having learned where the common problem areas occur and my hands picking up subtle changes in the texture of the tissue.

Doing dissections helped me to realize that some “ropey” things that I interpreted as pathological were, in fact, just tendons, like in the erector spinae or the semimembranosis. I once had an inexperienced massage therapist try to get rid of a neurovascular bundle in my upper arm because he felt something “stringy.”

Often enough, I’ll feel nodules or an area of increased tissue tension that’s tender and static pressure or other treatment will soften it and/or relieve the discomfort. It often seems more obvious in some muscles than others. But just as often I don’t particularly feel much at all or I feel something that I question and the client feels no discomfort. So, palpation is part of how I assess but not the only thing I rely on. And I never tell a cient, “Wow, you’re really tight!”

— Alice Sanvito, LMT, Saint Louis, Missouri

Notes

See For more detail, see another article on SaveYourself.ca, Stiffness, tightness and limited range of motion are not always the same thing: An interesting little thing to understand about your body. Return to text.
Andersen et al. “Increased trapezius pain sensitivity is not associated with increased tissue hardness.” Journal of Pain. 2010. Full Abstract:
Fatiguing exercise can affect muscle pain sensitivity and muscle hardness, as seen with work-related neck and shoulder pain. Objective methods to assess muscle pain sensitivity are important because the reliability of manual assessment is generally poor. The aim of this study was (1) to compare coexistence of tender points identified by manual palpation and pressure algometry or hardness assessments and (2) to examine the influence of exercise on muscle pain sensitivity and hardness. Fourteen sites in the upper trapezius muscle were selected for assessments in 12 healthy subjects. Pressure pain thresholds and muscle hardness were examined by computer-controlled pressure algometry at baseline, immediately after static or dynamic exercise, and 20 minutes after static or dynamic exercise. Before recording of pressure pain thresholds, the trapezius muscle was examined for tender points by manual palpation. Two sites with low pressure pain thresholds were typical locations for tender points, and these were the least hard sites. However, manually detected tender points were often (29%) not colocalized with most sensitive sites according to the pressure algometry. A heterogeneous distribution of pressure pain sensitivity and muscle hardness was found in the upper trapezius. The short duration of exercise until exhaustion did not change muscle sensitivity or muscle hardness in asymptomatic muscles.
PERSPECTIVE: This study confirms clinical findings with heterogeniosity in pain sensitivity and hardness across the upper trapezius muscle. Developments of new techniques that objectively identify tender points are important, but thus far, manual palpation is best clinical practice.
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