The Many Eyes of a Massage Therapist

From the moment a client walks through the door to the moment they leave, we must observe. When we are thorough and present in our observation skills, there is a nearly limitless amount of information available that can be used to effectively choose and apply the appropriate bodywork forms and techniques, resulting in the most beneficial outcomes.

We have our actual eyes, of course, that see the client’s gait, posture, movement quality, and mental/emotional state. But that’s only the beginning. We also have our hands’ eyes and mind’s eye that tune us in to a deeper level, therefore providing a deeper quality of therapeutic work. You likely were trained to use all your “eyes” in your massage sessions; however, a reminder of these vantage points is useful since they are many.

Your Actual Eyes

Being visually alert when your client arrives to the session, as well as throughout the intake process, can offer valuable information on what they may need from the massage experience and what approach(es) you might take. Whether it’s a first-time client intake, which will naturally be lengthier, or a returning client with a quicker check-in, it’s worthwhile to get in the habit of taking note of the following qualities:

Freedom of movement: Does the client move gracefully and freely, or do certain joints appear stiff, limited, or uneven?

• Symmetry: Is one shoulder higher than the other? Is one hip higher? Does the client slouch? Is the head held forward of the body? (Note: For clinically oriented sessions, a formal postural assessment would be indicated rather than a general observation.)
• Breathing patterns: Does the abdominal area expand when the client breathes? Do the ribs lift and expand? Is the client breathing rapidly or erratically, or is breath even, smooth, and relaxed?
• Level of sympathetic dominance: Is the client speaking loudly or quickly? Are they gesturing excitedly, demonstrating a high level of animation when speaking of a particular topic? Are they sweating or shaking? Do they appear fatigued or depressed?
• Body language: Is the client in a closed or open body position? (For example, rounded shoulders and a lowered head would be closed, while upright and facing you directly would be open.) Do they look you in the eyes? Is their jaw clenched?

The study of visual observation for client assessment is vast. For the purpose of this article, I simply invite you to take in what you see and let it guide your area of focus, the pace of your massage, and the choice to incorporate range-of-motion techniques or breathing exercises. It could even inform the type of music you use in the background. Each choice customizes the massage experience. (For more information on posture, gait, and ROM assessment, check out “Watch the Walk” in the May/June 2018 issue of Massage & Bodywork.)

Your Hands’ Eyes—Otherwise Known as Palpation Skills

Obviously, we focus on palpation skills in massage training. However, new and seasoned massage therapists alike can find themselves falling into a routine or allowing their mind to drift during a massage session. Massage therapists who take on several clients a day, day after day, tend to be susceptible to this and can miss some of the finer details. 

Those new to the field may simply need experience touching bodies to hone these skills. No matter the case, becoming present to the following qualities will create a feeling for the client of being seen, especially when you pause and say, “I feel something here. Do you?” What it takes is to put your attention directly into your hands and observe the following:

• Tissue tone and texture: Is the tissue grainy, crunchy, plump, smooth, full, liftable, stuck, taut, relaxed, unyielding, uneven, ropey, stringy, or knotty? Technical terms are not required to describe what you feel! Also, a single muscle can have variances from side to side and end to end that can clue you in to a line of pull (which is like a cairn along a path to follow).
• Temperature: Is the tissue cold, cool, warm, or hot? I once heard a massage therapist describe a small region of her client’s tissue as “having a fever.” Colder tissue signals compromised circulation, while warmer tissue signals inflammation. 
• Tissue hydration: Is the tissue stuck and hard rather than full and plump? Dehydrated tissue tends to not yield to your pressure easily and offers an additional reason to encourage your client to drink plenty of water.
• Structural asymmetry: You may have observed asymmetry in your visual assessment at the beginning of the session. Does the tissue tell the same story? Sometimes the side you think is going to feel a certain way doesn’t feel that way at all, which could cause you to shift directions in your session plan. Trust the tissue.
• Changes: It’s amazing and exciting to feel tissue yield to your touch! Be sure to note how tissue changes throughout the session as it will help you recall what the client’s body was receptive to so you can repeat that in subsequent sessions. Noticing these variances can inform you on which strokes to apply and where, whether to apply heat or cold therapies, and, as noted in the previous section, which areas to focus more time on. 

Remember as well that your “hands’ eyes” aren’t just in your hands. They are in your elbows, knuckles, forearms, and fingertips. The more you use various anatomical tools, the clearer the vision becomes.

Your Mind’s Eye

The mind’s eye is an extremely useful tool—especially for those still honing their palpation skills. Even if you can’t feel the coracoid process, for example, you can place it in your mind’s eye and call it to rise to your hands. While it may not literally rise, the process of creating a connection between a picture in your mind and your hands is powerful and can greatly support your process of learning. Let’s face it, there are a lot of structures to learn and understand. 

In addition, when you have a picture in your mind of what you are looking for, it’s more likely you will actually feel fiber direction, tone, and quality more readily. I can assure you that even if you don’t feel it precisely under your hands, or if it’s too deep to access directly, you can still impact it through your mind’s eye. 

The mind’s eye can even potentially encourage physiological processes. For example, in an ischemic area you can envision blood flow or in a swollen area you can envision a healthy functioning lymphatic system. You can train your clients to do the same. Current mind-body theories suggest this type of visualization can have profound impact on health. These are excellent reasons to know the body’s physiology.

Eyes Wide Open

It can be easy to overlook (or rather “underlook”) these details. They are a lot to attend to, and a steady, persistent presence is required. While it may seem overwhelming at first to notice it all, as with anything, practice makes natural. Before you know it, it will become second nature to see a muscle as you touch it; feel the various textures, temperatures, and other detailed qualities of muscle and connective tissue; and perhaps even palpate the inner workings of the various systems in the body. 

The more in tune you are, the more cooperative the body you are working on will be. Your work will go deeper and the results will leave you and your client wide-eyed with amazement at how therapeutic bodywork can really be.