Lumps and Bumps - when to refer..

Hi guys,

I'm fairly new to the boards altho I've been reading the boards for a bit.

I qualified as a Massage Therapist about a year ago and have slowly started to work part time from home. It's still very much a learning process for me but I'm thoroughly enjoying it.

I've not encountered too many real health issues in my clients so far.. but I had a client last night presenting with back and shoulder pain. Most of it waspretty typical computer related tension in his right Trap.. but he also had two large-ish knots in his left mid back.. one near to the spine and onefurther out around the area of hisbottom rib.

I've felt small pea sized knots before (and the odd trigger point), but these knots did feel larger - more like grape sized and very easy to feel. He had complained of some pain in this area and they were a little tender to the touch although fine for me to work on, but didn't seem to break down at all over the course of the massage.

The whole thing made me question at what stage I should suggest a client sees their Dr? If these lumps had been anywhere particularly suspect, ie, around the lymph nodes or in thebreast tissueI would probably have felt this was appropriate.. but in this case I didn't think so and thought the suggestion would have caused him unnecessary worry.

I'd be really grateful for either some reassurance or some guidance - have you more experienced therapists felt knots this large? I'm seeing the same client in 2 weeks time as he felt the massage really helped.

Thanks guys

Nat