By: Colleen O’Renehan

Deep Tissue is a term which is often overused as well as misused in the world of massage. It is my goal here to clarify exactly what deep tissue techniques are and to explain how they are best used. 

Clients often come to me requesting deep tissue work. In their minds deep tissue refers to using heavy pressure when doing a massage, almost all of them expect a heavy-handed full body Swedish massage. I have overheard massage instructors telling their students that in order to provide deep tissue massage, all they have to do is press harder. One student told me that she had been told to get a stool to stand on if necessary in order to provide more leverage. It is not about pressure, it is about finesse. 

To understand the process of deep tissue massage, we must first understand the nature of fascia. Fascia is the thin sheath of fibrous tissue which encases all muscle fibers. It is tensile in nature which means it can be stretched without breaking. Fascia provides pathways for nerves and blood vessels. When fascia is tight, it restricts the blood flow and potentially nerves as well. Without proper lymph and blood flow, cellular waste (toxins) accumulate in the muscle creating pain. Fascia also provides protection for the muscles. When it experiences fast/deep penetrating pressure, it tightens to prevent or minimize injury to the muscle. 

Fascia is thixotropic in nature; it can change states. It responds best to long, slow gentle tension. This gentle work warms the tissue and allows it to soften and relax. As the fascia begins to relax, the muscle that it encases is allowed to expand and elongate to assume it’s normal resting state. As fascia is designed to protect the muscles from deep penetrating pressure, fast or aggressive work on the fascia can actually cause it to tighten, producing more restrictions. One analogy I have used to assist in this visualization is cooking with cornstarch. Anyone who has placed cornstarch in a bowl, added water and begun to stir briskly can tell you it just doesn’t work. It creates a Non-Newtonian solution. The cornstarch molecules tighten into “concrete” when pressure is applied. Slow, gentle stirring however, quickly results in a homogenous suspension. Fascia responds in a similar fashion.  

Who can benefit from deep tissue massage? Almost everyone. Muscles tighten for a number of reasons including dehydration, shortage of particular minerals (potassium, magnesium, calcium) and energy sources (ATP)*, overuse, and injury. When addressing tight muscles these issues must be taken into account.  

Prolonged pathological hypertonus of muscles causes fascia to become tense. This in turn creates compression of muscle fibers, nerve tissue and blood vessels. This causes pain. We see this every day in a population addicted to computer and cellphone use. A healthy body with chronic tension resulting from overuse can benefit greatly from these techniques. Clients with Fibromyalgia respond phenomenally to properly applied deep tissue work. Deep tissue techniques can also be safely used with the proper training to treat muscle tension in prenatal clients. A dehydrated athlete low on electrolytes does NOT need deep tissue massage, in fact it can be very damaging to overtaxed, under nourished muscles. 

 So what is Deep Tissue Massage? Deep tissue massage is the gentle, systematic penetration of muscle tissue. It is not dissimilar to peeling away layers of an onion. Beginning with deep extended effleurage to warm and soften the fascia, the therapist will be able to feel the superficial layers of muscle “let go”.  As the superficial layers relax, the therapist’s hands will be able to sink ever deeper, feeling the adhesions and muscle contractions which lie below. Gradual, unhurried work can result in eradication of these issues without causing pain or discomfort for the client after the session is terminated. 

I hear you saying “So what about the elbows?” Elbows work great on trigger points. They can be gently used to sculpt muscles after they have been properly prepared for the deeper work, but digging in with elbows and thumbs before properly preparing the muscles is damaging and is very likely to cause pain for the client after the session. Trading one pain for another is hardly productive. 

My point here, is that many therapists are working way too hard to accomplish something that is really quite easily done if done properly. In talking to clients who have come to me with a “deep tissue” request, when questioned the majority of them are there to feel better. They are requesting “deep tissue” work because they are under the impression that an elbow is the only thing that is going to fix their issues.  

 What I really want impart to you today is that just because the only tool you have is a hammer doesn't mean everything has to be seen as a nail. If the only thing you know how to use is your elbow, find classes in neuromuscular, orthopedic, myofascial or other modalities to expand your toolbox. You don't have to become in expert in these modalities in order to utilize them in your practice. Your clients will thank you for it.

By: Colleen O’Renehan, LMT

  *ATP is a major energy source for muscular contraction 

  ** Judy Delany, one of our Neuromuscular gurus, as labeled effleurage as the single most effective tool in the Neuromuscular toolbox!