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The Many Levels of Pressure Levels (yes, I meant it that way)

Luckily for all of us, there are smart and practical people in the world. One of my favorite smart and practical people is Tracy Walton over in Boston. She taught me Oncology Massage Therapy, but has standardized Levels of Pressure for the entire world of massage therapists. She had the incredible good fortune to work with Gayle MacDonald and Dawn Nelson, who conceived of the idea and especially described the first two levels.

For those of you who have been sadly bereft and don't know about her levels of pressure, let me enlighten you.

Image: adorably smiley Tracy Walton in front of trees

Level 1 is considered "Light Lotioning."

Autocorrect simply does not accept the the word "lotioning," but it also doesn't accept "Autocorrect." Ironic.

Light lotioning is a full-hand contact but gentle level of pressure you might use to apply lotion, as though you had to apply aloe vera gel when you have a really bad sunburn.

Level 2 is "heavy lotioning," which is the pressure you use to rub in lotion, like the depth of pressure I'd use to rub sunscreen into the arms of a squirming toddler.

Level 3 is the gold standard "Swedish massage" relaxation pressure where you're starting to work the muscles instead of just gliding across them. You might see the nearby joints move a bit.

Level 4 is what most people want when they ask for "Deep Pressure." This is when I start really leaning on a client. This is the deepest most people can tolerate. Really, folks, trust me on this. Don't do the thing where you say "But you said DEEP PRESSURE" when you break their ribs.

And finally, Level 5 is the Hulk Smash of massages. This is where I might sink an elbow carefully into a strong client's glute or shoulder. Please notice I said "a STRONG client." Use it carefully and sparingly. And it still shouldn't cause bruises. I'm gonna say that again for the folks in the back. IT. SHOULDN'T. CAUSE. BRUISES.


There are some massage therapists who have measuring systems for pressure, such as Pounds per Square Inch. That's literally where they measure how many pounds of pressure they are using, and can calibrate accurately.


Finally, there's the perception of pressure from the client. One client's "deep pressure" is another's "light lotioning." This perception can change over time, with other illnesses, when tired, or when having a health flare.

When a client tells you "OUCH! That's way too much!" just accept it. Don't argue, "but I'm only using Level 3!" To them, it's too much. Suck it up, buttercup. You don't get to use your patented "Push Through To The Other Side" technique today.

SO, why do I care? Why does this matter at all?

Tracy's Levels of Pressure (TLOP) is vital to communicate with other massage therapists, for recording our own massage techniques for future reference, and to establish treatment plans. TLOP is a practical measurement of "what I'm doing and how it affects the tissues I'm touching." You can use this to explain what we do to other healthcare professionals, and that's vital when working in coordination with others.

The "Pounds Per Square Inch" method is supposed to perfectly and scientifically measure, calibrate, and document treatments. The main problem here is that nobody else knows how to measure PPSI. That renders it spectacularly ineffective in communicating with other professionals.

Client Perception of Pressure (CPoP) is important because ... well, massage is all about how the client feels! The problem for using this SOLELY as a measure of pressure is that PPoP changes from week to week, or even minute to minute. If the client is exhausted, Tracy's Level 3 might FEEL like super deep pressure to the client. Or to some enormous, muscley guy who just took 4 painkillers, an elbow deep in his traps might barely register.


(*too long, didn't read, also known as A Summary)

As therapists, we need Tracy's Levels of Pressure because it's clear, objective, and consistent, and we can use it to record or communicate what we DID.

We also need Client Perception of Pressure because it reflects how what we did (CPOP) felt to the client. This changes over time.

If you're going to be a good massage therapist (or preferably, a GREAT one), remember these and how to use them.

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