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One of the more common problems I have seen with deep tissue massage is with clients that are sore in the mid thoracic area following the massage. This soreness usually occurs the day after the massage, and it can persist for a long time.
This is caused by a therapist working deep into the paraspinal muscles in the mid thoracic area with clients that have a flattening of the thoracic curve, or even an anterior dishing of the vertebrae. Working deeply around these vertebrae and pushing them even more anterior may feel good at the time, but it will cause more pain later. Pressing anteriorly will jam the facet joints further and exacerbate the clients pain. It is important to recognize this and to work appropriately with these clients.
This anterior dishing of the vertebrae is referred to as Pottenger’s Saucer. It is named after Frances Pottenger, M.D., who first described a “saucer in the mid-thoracic spine”. Although it may be an osseous problem it is more commonly transitory and can be caused by chronic adrenal stress or problems with blood sugar.
The client shown in this video has a rather extreme dishing of her vertebrae, but I have seen clients with even a very mild flattening of the thoracic curve have pain after deep massage.
I have found that putting a pad or rolled up towel under the sternum when the client is lying prone will transmit pressure through the ribs and help to open the thoracic spine. Work then can be done in the area without pushing the vertebrae anterior.
If you have clients with this flattening of the thoracic curve do not do deep work near the spine in the upper back. You can work on their upper back more effectively in a sidelying position as you can work around the spine without pushing it anteriorly. The meltdown technique from the Deep Tissue Massage DVD is effective as you are working on the erector spinae as the client is slowly bending forward. The Erector Spinae technique from new techniques is also an effective way to work without putting undue stress on the thoracic spine.
What I have found helpful is to work on the client's upper back while using a pad under their sternum while they are lying prone, so that pressure is transmitted from the sternum through the ribs, causing more opening through the upper back.
A sternum pad or rolled up towel under the sternum also may be more comfortable for large busted clients as they lie prone on the table.
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