Deep tissue, a popular massage modality, involves applying firm pressure and slow strokes to reach deeper layers of muscle and fascia (see my Myofascial blog post). It’s used to release tight, contracted areas of muscles, as well as medical massage which is a specific and targeted style of deep tissue.
Deep tissue massage usually focuses on a specific problem, such as chronic muscle pain, injury rehabilitation, and the following conditions: Low back pain – Limited mobility-Recovery from injuries (e.g. whiplash, falls)-Repetitive strain injury, such as carpal tunnel syndrome-Postural problems-Muscle tension in the hamstrings, glutes, IT band, legs, quadriceps, rhomboids, upper back-Osteoarthritis pain-Sciatica -Piriformis syndrome-Tennis elbow-Fibromyalgia-Upper back or neck pain.
If you have never received a deep tissue massage, here’s what to expect. While some of the strokes may feel the same as those used in Swedish massage therapy, deep tissue massage isn’t a stronger version of a Swedish massage. Contrary to popular belief, deep tissue is not a pressure level, but a whole set of massage techniques. These techniques are used to break up scar tissue and physically break down muscle “knots” or adhesions (planes of stuff muscle glued together by sticky stuff in the body) that can disrupt circulation and cause pain, limited range of motion, and inflammation. At the beginning of a deep tissue massage, lighter pressure is generally applied to warm up and prepare the muscles. Specific techniques are then applied . Massage therapists may use fingertips, knuckles, hands, elbows, and forearms during a deep tissue massage. You may be asked to breathe deeply as the massage therapist works on tense areas. After the massage, you may feel some stiffness or soreness, but it should subside within a day or so.
Should Deep Tissue Massages Hurt?
At certain times during the massage, you may feel some low to high ranges of discomfort as the massage therapist works on areas where there are adhesions or scar tissue. True pain (OUCH! level) isn’t good, and it’s a sign that the pressure is too much. In fact, your body may tense up in response to pain, making it harder for the therapist to reach deeper muscles. You should always tell your massage therapist if you feel pain during the massage. The turning point between discomfort and pain is called “therapeutic threshold”. This can be described as a quick crossing or jump between discomfort to pain. It is OK for the therapist to work at the level of the therapeutic threshold during a massage, but should only be used for medical massage or when you find “that spot”. Some of the most productive parts of my sessions take place balanced on the therapeutic threshold. I always teach my clients about the therapeutic threshold so they can better communicate with me, which equals a better massage.
Definition of Discomfort and Pain:
Discomfort: In massage, there is a curious phenomenon widely known as “good pain.” It arises from a sensory contradiction between the sensitivity to pressure and the “instinctive” sense that the pressure is also a source of relief. So pressure can be an intense sensation that just feels right somehow. It’s strong, but it’s welcome. Good pains are usually dull and aching, and are often described as a “sweet” aching. The best good pain may be such a relief that “pain” isn’t even really the right word. Discomfort comes with no obvious, immediate benefits. If there is anything good about it, there is no way to tell from the sensation at the time. Discomfort can be sharp, throbbing, burning, or hot. Such pain is usually caused by excessive but generally harmless pressure. As bad as it feels, with the right application mostly likely won’t hurt you. I describe it to my clients as “therapeutic” and they laugh because they know that deep tissue is a vigorous and intense process, but yeilds true change.The big question about bad pain is whether or not it is ever justified.
Pain. This is a type of pain in massage therapy that is, by my definition, never okay. True pain is often caused by things that aren’t likely to offer even a delayed benefit, and may even be dangerous.
Side Effects and Precautions:
Deep tissue massage may not be safe for people with blood clots (e.g. thrombophlebitis or deep vein thrombosis), due to the risk that they may become dislodged. If you have blood clots or are at risk of forming blood clots, it’s essential that you consult your doctor first.
If you’ve had recent surgery, chemotherapy, radiation, or have another medical condition, it’s wise to check with your doctor before starting massage therapy. Some people with osteoporosis should avoid the deeper pressure of this type of massage.
If you have any condition, it’s important to consult your primary care provider first to find out what type they recommend. For example, people with certain conditions, such as ankylosing spondylitis, may not be able to tolerate the pain of a deep tissue massage.
Case reports have reported venous thromboembolism, spinal accessory neuropathy, hepatic hematoma, and posterior interosseous syndrome after deep tissue massage.
Deep tissue massage may also result in bruising if you have any kind of condition. A healthy client should not develop any bruising from massage. If you do bruise, please let your therapist know, because it means the pressure was too deep and should be adjusted next time.
Every body is different and massage pressure tolerance is incredibly varied. It fascinates me just how different people can be in this regard. Pressure that would be perfectly comfortable and soothing for one person would most likely cause severe pain and possibly emotional distress in another, and even injury. These differences can also occur between body parts. Pressures that worked well on the back can prove to be disastrously intense in the lower legs. Additionally, pressure tolerance changes with time: pressures that seemed fine on Tuesday can be brutal on Friday.
It is your massage therapist’s job to “learn your body” or, what techniques and pressures worked well and where for you specifically. This is why it’s good to see the same one or two therapists for regular massage so they can know your body well. When looking for a therapist, make sure you know if they specialize in deep tissue if that is what you’re looking for. That way you and your therapist can be confident that you are a good match and can explore deep tissue massage together for healing’s sake.
Rielle Pruitt, Seattle Massage Oasis