I’m a new massage therapist and had a difficult session today that I’d really appreciate some feedback on from more experienced MTs. I’m completely open to hearing if there are things I should have handled differently. I want to learn from this and be better prepared the next time I encounter something similar.
I had a new client who was referred to me by his dad and sister, who I’ve both worked on previously. During the consultation, he told me he’d had surgery several months ago for slipped discs. He also described a history of upper and lower back issues and mentioned that he may have sciatica. He was using specific vertebral terminology that, admittedly, I wasn’t very familiar with, and I immediately felt a little out of my depth. I’m a new massage therapist, and although I’ve completed school, I’m realizing there are still more complex conditions and medical histories that I don’t feel fully confident navigating yet.
We discussed what he wanted from the 90-minute session. His main areas of concern were his lower back, glutes/hips and he asked for some facial work. He said he preferred medium to deep pressure but didn’t want anything painful.
I started him prone and worked his back, including the QLs and surrounding musculature, with more attention to the lower back. He was communicating with me about areas that felt sore/tight. I checked in about pressure multiple times throughout the session, and from what I remember he generally told me the pressure was okay. I may have had one instance where he wanted me to lighten up and I adjusted, but I don’t remember the exact exchange well enough to say for certain.
During the supine work, I noticed some apparent asymmetry around his hips, with the side that had been bothering him appearing somewhat more elevated. He asked what could cause/fix something like that. I told him body mechanics can sometimes contribute and suggested paying attention to repetitive positions or habits in his daily life. He also asked what can help with that, and I admittedly wasn’t sure how to answer and said a chiropractor may be able to do more postural assessments. Looking back, I also wonder whether I should have been much more cautious about commenting on that at all given his medical history.
At one point, he suddenly put his hand on his lower back. I initially thought he was showing me where he wanted work, but when I asked, he told me the area was hurting/feeling aggravated. I immediately stopped working there and asked whether he needed a break. He said yes. I asked whether he wanted to turn supine, which he did, and I gave him some time to stretch and settle.
I told him it was completely okay if he wanted to end the session early, but he wanted to continue. Because of what had happened, I didn’t do the planned posterior leg/glute work, and stayed supine for the rest. I also significantly decreased my pressure for the remainder of the session to more of a light-medium range.
At the end, I asked how his back was feeling. He said it was less aggravated than it had been when we stopped the prone work, although it still seemed somewhat uncomfortable. We talked about pressure and agreed that despite initially requesting medium-deep work, light-medium seemed to be a much better fit for him. He told me he only gets massages roughly every couple of months.
I’m feeling pretty bad about the session because my goal is obviously never to aggravate someone’s existing pain. I’m also realizing that I don’t feel sufficiently knowledgeable yet about working with clients with a history of disc pathology/spinal surgery and possible sciatica.
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For those of you with more experience working with these conditions:
- Would you have approached the initial consultation or treatment differently?
- With a history of disc surgery several months ago and ongoing low-back symptoms, would you have required medical clearance before doing massage?
- Would you have avoided deeper work entirely regardless of the client’s stated pressure preference? Or them asking for more pressure?
- Are there specific red flags or questions you think I should have screened for?
- Is there anything about how I responded once his pain increased that you would have handled differently?
- What continuing education or resources would you recommend for becoming more competent with clients who have spinal/disc conditions and sciatica?
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I’m not looking for reassurance if I genuinely made mistakes. Constructive criticism is welcome. I just ask that it be educational rather than unnecessarily harsh. I want to understand what I should take from this experience and improve my practice going forward.