Deep Tissue Massage – Outdated terminology.

Deep Tissue Massage is a term used by massage therapists that describes the amount of pressure that is applied during a massage or it can also mean a technique that focuses on releasing the deeper myofascial restrictions of the deeper muscles, tendon and ligaments of the body.   This work is also sometimes referred to as myofascial release and is used by many massage therapists, physical therapists and osteopaths. There are many theories and concepts that have evolved around doing deep tissue massage from the various types of therapists that use the technique. The terminolgy we use is confusing to the public, other health practitioners and our own profession. Refer to this updated article on deep tissue massage.

There are many different combinations of various techniques of deep tissue (myofascial release) with different purposes or intent. Some use very forceful pressure while others use gentle rocking or very light pressure with the same results – a releasing of the deeper structures of the body. Some of the various techniques include :Rolfing and Structural Integration, Neuro-Muscular Therapy, Craio-sacral Therapy, Polarity Therapy, Travell Triggerpoint therapy, Pfrimmer Deep Tissue, Postural Integration, Soma Neuromuscular Integration, Thai Massage, Trager and many others. 

Principles of Deep Tissue Massage

Narrative review Deep tissue massage: What are we talking about?
Yogev Koren, BPT, Leonid Kalichman, PT, PhD.

This narrative review suggest using the aforementioned definition of DTM proposed by Riggs (2007) concomitantly with the following principles:
1) Slow strokes.
2) Diagonal applications (except for treating MTrPs).
3) Maintaining depth of treatment according to targeted tissue.
4) Understanding of the differences between deep and forceful applications.
5) Using body weight to generate the force transmitted through the hands, knuckles or elbows.
6) When working on a muscle belly parallel and cross-fiber strokes should be included.
7) Include stretching or activation of muscle.
8) Special attention to origin and insertion of muscles.
9) The application should be within the client’s parameters of comfort (minimally painful or no pain at all)

Methods of Application of Deep Tissue Massage Therapy

There are many various levels and planes of fascia that can be accessed through the application of specific pressure.  The major method of access regardless of the type of stroke one uses in deep tissue therapy is through the intent behind the touch.

You can use the following general rules for focusing your intention to access the various levels of fascia.

  1. Direction of pressure is determined by the direction of the resistance in the myofascial structure.  Press directly into the resistance of pull from the resistance depending on the intent.
  2. Depth is determined by the level of the tissue to be treated and the minimum amount of pressure required to engage the resistance in that tissue.
  3. Duration is determined by the rate of release in the muscular reflexes and the rate of change in the ground substance of the connective tissue.
  4. Pressure is applied only to the minimum level necessary to obtain access to the tissues and is necessary for the self care of the therapist.
  5. To develop effective techniques, the practitioner must develop skill in palpation of the musclo-skeletal system and fascial structures.
  6. Deep tissue massage/bodywork is only a tool to set up a framework for developing a therapeutic relationship which is really the core of healing.  The practitioner who is aware of their codependent tendencies and other dysfunctional behaviors will be the most successful and effective.  The process of peer supervision can support the therapist in this process.
  7. Practitioner awareness is necessary when doing deep tissue massage.  Proper body mechanics and using the weight of one’s body to apply pressure is one part of awareness.  The other is the awareness of one’s self (see #6 above)
  8. Intuition needs to be activated and always improved upon to stay as present with the client as possible.  Intuition is a combination of applying knowledge and experience while you are staying present with what you are feeling in your own body as a result of the interaction with the client.
  9. The practitioner needs to stay present to observe physical, emotional, mental and spiritual changes taking place in the clients body.
  10. The best form of feedback is how you feel (not the client).  We are always reacting and responding to others based on our own needs at the time.  You are a mirror for the receivers of the deep tissue massage.  Use your feelings to guide your touch.

Qualities, Intentions and Purposes of Deep Bodywork

Deep Tissue Bodywork is applied with the intention of accessing the deeper layers of the body.  Pressure is applied with the intention of finding the resistance of the body and sustaining the pressure until the resistance is released.  This is called a direct technique. 

There is also an indirect method that moves in the opposite direction of the resistance.  In both instances the amount of pressure used is dependent on the amount of resistance in the tissue and using the minimum amount of engagement needed to release the tissue.

Contrary to some popular beliefs that “no pain, no gain” and “more is better”, deep tissue massage does not require great strength nor does it need to be painful.

Creating a clear intention is what creates effective results.  Some of the qualities, intentions and purposes of deep massage/bodywork include:

  1. It is sensitive to the state of receivers and requires that the giver have a highly developed awareness of themselves and others.  The intention is to increase the receivers’ awareness and sensitivity.
  2. The increased awareness of the practitioner results in mirroring of the clients’ body tension.  Using Deep tissue massage techniques allows the receiver to become more aware of holding patterns and the emotional content that is stored there.  It is important that the practitioner learn to be of service and be able to set aside their agendas in order to adequately meet the clients tissue and provide the listening (through their hands, ears and eyes) that the client needs.
  3. Increasing the receivers awareness allows the work to go even deeper.
  4. It is effective in releasing deeply held emotions that cause tension thereby resolving many chronic pain patterns.
  5. Deep tissue massage may help improve the functioning of the internal organs and any associated symptoms or diseases.
  6. Improves posture and re-establishes proper movement of muscles.
  7. Releases myofascial restrictions for optimal health.
  8. Deep tissue massage done with intention and awareness can help reduce the automatic reflexes to stress thereby creating less tension
  9. Is effective in working on injuries and the resulting compensations in other areas of the body.
  10. Emotional stability can result as the deeper restrictions are released.

Defining Deep Tissue Massage

Guidelines for Giving Deep Tissue Massage

Guidelines for Receiving Deep Tissue Massage

History of Deep Tissue Massage