Deep Tissue Massage

Deep Tissue Massage Therapy

Deep Tissue Massage Therapy is defined by the Massage Therapy Body of Knowledge as:

“Deep Tissue – Description of the tissues beneath superficial structures which are being treated and not the techniques employed. This term is commonly misused to describe a specific technique.

Deep Tissue Work/Massage– A generic term commonly used to describe a variety of techniques to address specific deep tissues and structures, regardless of the force/pressure being exerted or level of discomfort/pain experienced during and/or resulting from the application.”

The ELAP Blueprint says this about Deep Tissue:

“Deep tissue incorporates method from myofascial and neuromuscular approaches.”

Deep Tissue Massage therapy is often misunderstood and many massage therapists will define it in their own way. Some massage therapists call neuromuscular therapy deep tissue massage and also confuse it with myofascial massage. If you are getting a massage, it is important to know what the definition of deep is that the massage therapists is using.

ABMP (On defines deep tissue massage as:

Techniques that use deep-tissue/deep-muscle massage are administered to affect the sub-layer of musculature and fascia. These techniques require advanced training and a thorough understanding of anatomy and physiology. The muscles must be relaxed in order to effectively perform deep-tissue massage, otherwise tight surface muscles prevent the practitioner from reaching deeper musculature. It helps with chronic muscular pain and injury rehabilitation, and reduces inflammation-related pain caused by arthritis and tendinitis. It is generally integrated with other massage techniques.

More Definitions of Deep Tissue Massage Therapy

“The systematic manipulation of soft tissue with the hands that positively affects and promotes healing, reduces stress, enhances muscle relaxation, improves local circulation, and creates a sense of well-being.” Although this definition does not encompass every form of massage (e.g., self-massage with a roller), it appears to encapsulate the general concept as perceived by the general public as well as professionals. DTM falls under the above-mentioned definition, however, it is unclear as to what elements define DTM and renders it different from other methods.

Crawford et al. 2016 Crawford C., Boyd C., Paat C.F., Price A., Xenakis L., Yang E.M., and Zhang W.: The impact of massage therapy on function in pain population. A systematic review and meta-analysis of randomized controlled trials: Part I, patients experiencing pain in the general population. Pain Med. 2016; 17: pp. 1353-1375

And another:

Deep massage should be used to describe the intention of the therapist to treat deep tissue by using any form of massage and deep tissue massage should be used to describe a specific and independent method of massage therapy, utilizing the specific set of principles and techniques as defined by Riggs: “The understanding of the layers of the body, and the ability to work with tissue in these layers to relax, lengthen, and release holding patterns in the most effective and energy efficient way possible within the client’s parameters of comfort”.
Deep tissue massage: What are we talking about? Yogev Koren BPT and Leonid Kalichman PT, PhD Journal of Bodywork & Movement Therapies, 2018-04-01, Volume 22, Issue 2, Pages 247-251, Copyright © 2017 Elsevier Ltd

 And another:

Art Riggs (Deep Tissue Massage, Revised Edition 2007) defined DTM as “The understanding of the layers of the body, and the ability to work with tissue in these layers to relax, lengthen, and release holding patterns in the most effective and energy efficient way possible within the client’s parameters of comfort”. This definition may encompass the full concept of the method, but it is too open for interpretation to serve as a baseline definition for research.

The Depth in Deep Tissue

Deep Tissue Massage can mean that the massage therapist is working with the deeper structures of the body like the Psoas muscle, Pectoralis Minor or Deep Hip Rotator Muscles.

Deep tissue massage can also mean applying really forceful and deep pressure to muscles of the body. The therapist will use their fists, elbows and often climb on the table to get better leverage to apply more pressure. Deep tissue massage can also cause bruising and pain after a session. It can leave you feeling worse initially after a session in some cases.

Old Style Rolfing is a form of really, really deep pressure applied to the muscles. It was meant to be painful or so the students thought except when Ida had her hands on people, it was not painful. Newer style Rolfing uses less pressure and say it should not be painful.

Whether or not deep tissue massage is painful or not depends on the therapists views of the definition of deep tissue.

The Goal of Deep Tissue Massage Therapy

Deep Tissue Massage is a really not a type of massage but just a change in pressue, that is geared more toward improving range of motion and relieving pain (which most other types of massage therapy can do also.) It is may or may not be specifically geared toward relaxation, although a person can feel more relaxed when out of pain and can move better.

Research on Deep Tissue Massage Therapy

The issues of not having a clear definition of deep tissue massage makes it difficult to do research or analyze research studies.

Deep tissue massage had positive effect on reducing pain in patients with chronic low back pain

Deep Tissue Massage and Nonsteroidal Anti-Inflammatory Drugs for Low Back Pain: A Prospective Randomized Trial. e Scientific World Journal Volume 2014, Article ID 287597, 7 pages Marian Majchrzycki,1 Piotr Kocur,2 and Tomasz Kotwicki

We investigated by questionnaire and our results shows that both massages has direct effect on CLBP. Deep tissue massage was statistically significant better therapy than therapeutic massage. Deep tissue massage use soft-tissue manipulation component which are effective in the nonpharmacological management of subacute low back pain.
A comparison of the effects of deep tissue massage and therapeutic massage on chronic low back pain. Mateusz ROMANOWSKI a, 1, Joanna ROMANOWSKA b, Marcin GRZEKOWIAK. doi:10.3233/978-1-61499-067-3-411

The analysis of articles revealed evidence for the incorporation of DFM in the treatment of tendinopathy. Comparison of studies was made difficult by the varied location of tendinopathies, confounding cotreatments in comparison groups, and varied outcome measures used.
Much of the original rationale for the use of DFM remains
valid in light of a complete shift in understanding of the pathogenesis of tendinopathy. Future randomized comparison studies are necessary that incorporate true control groups and compare DFM in isolation with other modes of treatment. Studies such as these are very difficult to
undertake, as they inherently deny treatment to a group
of participants.

Deep Friction Massage to Treat Tendinopathy: A Systematic Review of a Classic Treatment in the Face of a New Paradigm of Understanding Michael F. Joseph, Kathryn Taft, Maria Moskwa, and Craig R. Denegar.

Our study suggests that the use of deep tissue massage and therapeutic massage might have therapeutic results and that supplementing the comprehensive rehabilitation of an AS patient could be considered for use. The results obtained due to the small size of the groups do not allow for final conclusion about the role of massage in the treatment of AS but are very encouraging and can stimulate further studies in this field.

Comparison of Deep Tissue Massage and Therapeutic Massage for Lower Back Pain, Disease Activity, and Functional Capacity of Ankylosing Spondylitis Patients: Randomized Clinical Pilot Study.

This study defined deep tissue as: “The massage therapist gave a series of 10 back massages intended to identify and alleviate musculoskeletal contributors to the participants’ lower back pain. It was performed by using trigger point therapy and oblique pressure for a combination of lengthening strokes (extending a particular joint while at the same time working the muscle in the direction of the lengthening), cross-fiber strokes (rolling the fingers over the tendon or muscle, back and forth, perpendicular to the fiber direction for two or three minutes), anchor and stretch (anchoring at a tight area and stretching away from the spot), and freeing muscle from entrapment (mobilizing the erector spinae muscle in the lateral/medial direction by using both fingers of both hands to apply force along the border of the muscle and slowly push the muscle towards the opposite side).”

That is not any deep tissue that I ever heard of…

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History of Deep Tissue Massage