As long as necessary
One thing I try and preach to my students at the massage school is patience during their treatment sessions. We often rush through things and in doing so (a) fail to get the changes we want and be (b) over look all the potential ramifications of our treatment.
Rushing (or forcing) a treatment doesn’t stop with young massage therapists though, as we often see this with other professionals performing manual therapy as well. I treated a competitive CrossFit athlete who was in town this weekend and he commented about how the chiropractor that he goes to back home only does a“few passes on his subscapularis and a few passes on his latissimus dorsi“and that is a treatment. The problem with this isn’t the structures that are being treated but the neglect for the time it takes to make the changes we want to see, especially in certain types of people.
Soft tissue therapy takes time and patience. There is a lot more going on than just trying to influence muscle tension. The outcome of our treatment can have profound effects on a more global level and sometimes it takes time to get the body to relax and get into a state where these changes can occur. I have found this to be especially true with those who are more sympathetically dominant. There tends to be a lot more prep work that needs to take place in order to get them relaxed enough to address specific structures – otherwise you are just fighting their nervous system to get anything done and oftentimes this leads to them tightening up even more or having a negative result from the treatment.
The key to good treatment is patience and having a touch that is receptive to the body. None of this can happen with a few passes on this muscle and a few passes on that muscle. Different people will have different rates of adaptation and sensing this within each individual client takes time. Additionally, don’t just think about individual muscles but rather, keep the idea that you are influencing a living (and adapting) physiological system in the back of your head. The autonomic nervous system may be a big player in any sort of touch therapy so keep that in mind!
So, how long should soft tissue work take?
As long as necessary. For some that may be 30min and for others that may be 90min (maybe more in some cases). It all comes down to:
a) What things need to be addressed – This comes from your assessment and understanding of the goal of the treatment – general, specific, therapeutic (stress reduction), treatment based, etc.
b) How is the person adapting to the treatment – This can be influenced by their autonomic state (sympathetic vs. parasympathetic), the individuals level of fitness, feedback you can getting from the client during the treatment (both verbally and your tactile perception), and test-treat-retest. Keep in mind that there may be times that treatment needs to be altered (cut short, lengthened, multiple treatments per day, etc) depending on the individuals response.
Slow down, wait for them to adapt to you (don’t force it), be patient.