An In-Depth Guide to Deep Tissue Massage - Massage Magazine

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According to the National Center for Complementary and Integrative Health, approximately 15.4 million American adults (6.9 percent) and 385,000 children (0.7 percent) have used massage therapy services.

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According to the National Center for Complementary and Integrative Health, approximately 15.4 million American adults (6.9 percent) and 385,000 children (0.7 percent) have used massage therapy services.


These numbers will likely increase in the years ahead, with the Bureau of Labor Statistics reporting that the industry is expected to grow by 26 percent between 2016 and 2026, an amount that is “much faster than the average for all occupations.”

While there are numerous types of massage available—Swedish, aromatherapy, hot stone, and more—each one requires a different technique and serves a different purpose.

Additionally, there are some massages that tend to be requested more often than others. One that fits into this category is deep tissue massage. Keep reading and learn more about the benefits of deep tissue massage.

What is Deep Tissue Massage?


“Deep tissue massage is a specific type of massage that works on the deep layers of muscle and fascia in the body,” says Sonya S. Bykofsky, BCTMB, of A Touching Experience Integrative Bodywork Services in Lenox, Massachusetts.

Using fried chicken as an example to help others better understand the interplay between muscles and fascia, Bykofsky explains that “the fried outer layer is the skin, the meat is the muscle, and the shiny stuff you see covering the meat is the fascia.”

Sometimes this technique involves the therapist using firmer pressure to reach these key areas and get them to release, which is why this particular massage is often recommended for people who are comfortable with a slightly more intense touch.

However, deep tissue massage can also refer to gentle yet sustained pressure targeting the myofascial layer.

David Everhart, PTA, LMT, practices massage therapy at Structural Elements in Hagerstown, Maryland, and he adds that deep tissue massage creates positive changes for positive health effects.

“Deep tissue work creates physiological changes in the tissue that then create systemic changes,” Everhart explains. “By allowing layers to move independently and slide or glide upon each other, we can improve big-picture posture, lengthen the spine, and improve the quality of the soft tissue.”

Deep Tissue Versus Other Types of Massage


How is deep tissue massage different from other types of massage, such as Swedish massage, for instance?

“Deep tissue works all of your connective tissue and fascia,” says Bykofsky, “as opposed to Swedish massage, which is more superficial.”

The techniques are also different depending on the type of massage being given.

For example, one 2012 study published in Studies in Health Technology and Informatics shares that deep tissue massage “uses oblique pressure, a combination of lengthening and cross-fiber strokes, anchor and stretch, freeing muscle from entrapment.”

This is different than therapeutic massage, a type of massage that researchers explain uses “effleurage, petrissage, tapping and friction.”

Different types of massage can also provide different outcomes.

For example, this same study involved 26 chronic low back pain patients between the ages of 60 and 75 who were split into two groups.

One group contained 13 individual, or one-half of the total participants, and each person received 30-minute therapeutic massage sessions for a period of 10 days.

The remainder of the participants (again, 13 in total) received deep tissue massage for the same timeframe.

Participants were assessed based on three different scales—Modified Oswestry Low Back Pain Disability Index (ODI), Quebec Back Pain Disability Scale (QBPD), and Visual Analog Scale (VAS)—both before and after the study.

Based on the results, researchers concluded that, when it comes to chronic low back pain, deep tissue massage “was statistically significant better therapy” than therapeutic massage with regard to ODI and VAS.

Other studies involving different conditions have found similar results.

For instance, in 2017, a study published in Evidence-Based Complementary and Alternative Medicine looked at 27 men who had been diagnosed with ankylosing spondylitis, or AS.

The Spondylitis Association of America explains that AS is a condition characterized by inflammation in the spine, which can eventually lead to a new bone formation in which certain sections of the spine “fuse in a fixed, immobile position.”

In this study, the men were also split into two groups.

One group received therapeutic massage in an effort to ease lower back pain, improve function, and induce relaxation.

The other group engaged in deep tissue massage designed to “identify and alleviate musculoskeletal contributors to the participants’ lower back pain.” Both groups participated in a total of 10 massage sessions.

Upon conclusion of the study, participants answered six questions about their fatigue, pain, tenderness, and stiffness via the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).

Those who underwent deep tissue massage “showed a significantly greater reduction in BASDAI” when compared to the therapeutic massage group.

They also showed a greater reduction in pain.

This isn’t to say that deep tissue massage is better than therapeutic massage, but that different modalities are more effective for certain conditions than others.

So, what types of benefits does deep tissue massage provide?

Benefits of Deep Tissue Massage


Massage is known for its ability to help the mind and body relax, and that alone makes getting them advantageous.

However, research has found that deep tissue massage specifically can bring clients other benefits as well. Here are a few to consider.

Deep tissue massage eases pain

Deep tissue massage sometimes helps to lessen pain.

For example, research published in an April 2014 issue of Manual Therapy found that deep tissue massage to posterior calf muscles combined with self-stretching exercises helped reduce participants’ pain associated with plantar fasciitis.

This is important as a study in the Journal of Research in Medical Sciences reports that plantar fasciitis is the most common cause of heel pain, appearing in 11 to 15 percent of the cases.

Deep tissue massage can be used for other pain-based conditions as well.

One that has been studied quite frequently is fibromyalgia.

According to a 2014 study in PLOS One, individuals with this condition sometimes experience “beneficial immediate effects” in regard to their levels of pain, oftentimes within just five weeks of massage therapy.

Participants in this study also reported lower levels of anxiety and depression.

Deep tissue massage makes movement easier

Scar tissue forms when an area of the body is injured and then heals.

Although the most common scars are those that result from a visible cut, sometimes they occur deeper in the body, such as when you damage muscles, ligaments or tendons.

It is this type of scarring that deep tissue massage can help resolve, making it easier to move and promoting greater range of motion.

Research confirms the value of massage for range of motion, with a 2017 systematic review and meta-analysis in the Journal of Physical Therapy Science finding that, after review of seven studies and 237 participants, massage therapy “significantly improved” range of motion for individuals in their shoulder area.

This was especially true with regard to movements involving flexion and abduction.

Deep tissue massage can improve function of the heart and lungs

Deep tissue massage is also beneficial to many of the body’s internal organs.

For instance, a study published in 2008 in the Journal of Alternative and Complementary Medicine involved 263 participants who reported muscle spasm or strain.

Each individual’s blood pressure and heart rate were assessed prior to a 45 to 60-minute deep tissue massage, as well as after.

The result was lower systolic and diastolic pressure, as well as heart rates around 10 beats less per minute.

Massage has also been found to improve lung function.

A 2017 study in the International Journal of Chronic Obstructive Pulmonary Disease shared how 12 patients with severe chronic obstructive pulmonary disease (COPD) engaged in massage therapy one time and their residual volumes decreased while their inspiratory capacity and SpO2 increased, signally healthier functioning of the lungs.

Deep tissue massage offers more effective stress relief

When a client feels stressed out due to demands at work, home, or both, deep tissue massage can help ease this stress in a healthy manner.

This is important as unresolved stress can do major damage to mental and physical health, with an estimated 60 to 80 percent of doctor’s office visits being stress-related as noted in a 2003 study in the Journal of the National Medical Association.

Massage can also help with chronic tension headaches according to research published in the American Journal of Public Health.

This particular study involved individuals who reported experiencing two or more headaches per week for a period of six months or more, and each participant received two 30-minute massages weekly for a period of four weeks.

The results indicated that the mean number of headaches per week decreased from 6.8 to 2.0.

The mean duration decreased as well, with the average headache lasting between 2.3 and 4.3 hours, as opposed to the pre-study duration of 4.3 to 8 hours.

Seventy-five percent of the participants also reported improvement in headache intensity.

Deep tissue massage for improved social bonding

Research conducted at the University of California Los Angeles (UCLA) has even found that massage can help facilitate social bonding.

It does this through the touch of the massage therapy, which increases the body’s release of oxytocin, a hormone that Medical News Today reports as being “associated with empathy, trust, sexual activity, and relationship-building.”

There are many benefits associated with deep tissue massage, further reinforcing why this type of massage is requested so frequently.

What makes it so good for the body?

Deep Tissue Massage Techniques and Uses


When discussing the positive benefits of deep tissue massage, it helps to first understand the techniques used in this type of massage therapy.

Though some of these techniques are basic methods of performing deep tissue work, individual therapists tend to shape and mold them slightly based on their own individual preferences.

Techniques Used in Deep Tissue Massage


Bykofsky shares that “some techniques traditionally used in deep tissue work include myofascial release, cross fiber work, and friction.”

She also has her clients use breath work and sometimes movement in deep tissue sessions.

“For me, deep tissue work is a working relationship between myself and the person receiving,” she says.

Everhart states that he uses a variety of techniques to do deep tissue work as well, some the same and some different than those used by Bykofsky.

“Manual techniques include myofascial and positional release, trigger point therapy, use of stainless steel tools, and range of motion (both passive and active) with pin and stripping of the focal adhesions,” he says. “Everhart says he also uses gravity, bolsters, and the massage table itself “to improve alignment and posture.”

Conditions Deep Tissue Helps Relieve and/or Treat


The specific conditions that often respond well to these techniques are numerous. However, some of the most common include:

• 
  Chronic back pain. The American Academy of Pain Medicine (AAPM) reports that 100 million Americans suffer from chronic pain, with is more than those afflicted with diabetes, coronary heart disease, stroke, and cancer combined. Additionally, back pain is the most common type of pain reported, accounting for 27 percent of all chronic pain cases. It is also the leading cause of disability in Americans who are 45-years-old or younger. Research has found that deep tissue massage can potentially help ease this pain, offering these individuals a chance at a higher quality of life.
  

• 
  Headaches. Severe headaches and migraines are the second most common pain conditions in the U.S. (15 percent) according to the AAPM, and Everhart says that massage therapy can oftentimes help in these cases. The Migraine Relief Center (MRC) indicates that the reason this modality works is that it eases muscle spasms, improves blood flow and circulation, relieves tension, and increases relaxation. The MRC shares that it is also especially helpful when it comes to tension and vascular headaches.
  

• 
  Neck pain. Neck pain is tied with headaches as the second most common pain experienced by adult Americans (also 15 percent), and massage can typically help with this too. For instance, a systematic review and meta-analysis published in 2014 in Evidence-Based Complementary and Alternative Medicine analyzed 15 studies and found that there was “moderate evidence” that massage therapy helped provide relief.
  

• 
  Shoulder pain. A 2017 study published in the Journal of Physical Therapy Science reports that shoulder pain is one of the most common musculoskeletal disorders, affecting as many as 66.7 percent of the population. The study goes on to say that massage therapy can often help reduce this type of pain, sometimes in a matter of days, though 36 sessions appeared to offer the greatest level of relief.
  

• 
  Plantar fasciitis. According to the JAMA Network, plantar fasciitis occurs when the fibrous band on the bottom of the foot becomes irritated and inflamed, causing pain in the heel and arch areas. The Pacific College of Oriental Medicine further indicates that deep tissue massage can be an effective treatment for this particular condition as it helps “release the muscle tension, break scar tissue, and lead to its elimination.”
  

• 
  Posterior interosseous syndrome. Physiopedia explains that posterior interosseous syndrome is a compression of the posterior interosseous nerve, which is located near the shaft of the humerus and the elbow, that may result in paresis or paralysis of the thumbs and fingers. Though cryotherapy, ultrasound, dry needling, and other modalities often help with this condition, so too does deep tissue work that is focused on the thoracic outlet, pectoralis minor, triceps, brachioradialis, and other surrounding areas.
  

Client Considerations


With deep tissue massage, many questions often exist regarding how often clients should get this type of massage, who these types of massages are not appropriate for, potential side effects, and whether or not deep tissue work releases toxins. Let’s look at each of these answers now.

How often should clients get deep tissue massages?

Bykofsky says that the frequency with which clients get deep tissue massages varies as it is dependent on the person and their issues.

“Often times, for a person that holds a lot in their bodies, I may suggest a few sessions close together to start,” says Bykofsky. She then “spaces sessions further apart until they can reach a point of maintenance, which I recommend monthly.”

For patients with a specific pain complaint, Everhart has them schedule weekly visits for the first three or four weeks.

“This allows for the body to accommodate to the new tissue lengths and angles of pull on the bony structures,” he says. “With soft tissue having a great memory of previous positions, it takes a few sessions to achieve the desired posture.”

Once a patient has moved out of an acute phase, Everhart then recommends deep tissue treatment once every three to six weeks as maintenance, depending on the amount of stress (both physical and emotional) being placed on the body.

“Injury prevention is a major component to overall health and wellness,” says Everhart. “The more active role the patient takes in their own wellness, the better the results.”

Who shouldn’t get a deep tissue massage?

Deep tissue massage isn’t for everyone, and Bykofsky shares that this includes:

• 
  Anyone taking a blood thinning medication
  
  
• 
  Those at risk for blood clots
  
  
• 
  Individuals with recent trauma to the body (whether due to surgery or an accident)
  
  
• 
  Persons undergoing radiation or chemotherapy
  
  
• 
  People diagnosed with lymphodema
  

Bykofsky adds that those with severe osteoarthritis should also avoid deep tissue work.

The Arthritis Foundation agrees, indicating that, because deep tissue massages can create a “lingering soreness,” making these types of massages sometimes inappropriate for individuals diagnosed with arthritis.

This is why it is so imperative that massage practitioners obtain a complete medical history for their clients, says Bykofsky. Some of these issues may be revealed via a thorough questionnaire, better protecting the client and the practitioner as a result.

Hillary Tinapple, LMT, CST, with Inner Oasis Craniosacral, which operates out of San Diego, California and Seattle, Washington, also suggests that deep tissue massage isn’t for individuals with sensitive systems.

“If someone has had difficulty receiving massage comfortably in the past or if they have experienced complications after receiving a massage (pain, bruising, emotional upset), they are not an ideal candidate for deep tissue,” says Tinapple. In this case, “it may be worth exploring another type of massage modality,” she says.

What are the potential side effects of a deep tissue massage?

Because deep tissue massage is generally administered using more pressure than many of the other types of massages, some side effects may be noticed by the client after the session is complete. These include:

• 
  Bruising. While some clients do experience bruising, Bykofsky stresses that “every massage therapist should understand that deep tissue massage does not have to be painful. I have seen clients who come to me with substantial bruising—and in more pain—after seeing other therapists for deep tissue work. That's absolutely unnecessary.”
  
  
• 
  Venous thromboembolism. A case study published in the Physician and Sportsmedicine reported that a “previously healthy 67-year-old man” developed a venous thromboembolism—a blood clot that forms in the arm, leg, or groin, which travels to the lungs—after receiving a vigorous deep tissue massage.
  
  
• 
  Spinal accessory neuropathy. Another case study, this one published in the Archives of Physical Medicine and Rehabilitation, revealed that one client developed spinal accessory neuropathy after a deep tissue massage, causing “scapular winging and droopy shoulder as a result of weakness of the trapezius muscle.”
  
  
• 
  Hepatic hematoma. Hepatic hematoma is a painful liver condition, which The New England Journal of Medicine says has been instigated by deep tissue massage. In this case, a 39-year-old woman received a deep tissue massage, which included the abdomen and right upper quadrant. Within 24 hours, she developed abdominal discomfort, nausea, and pain in her right shoulder. A large hematoma was found in her right hepactic lobe, causing the woman to feel nauseous and have a fever for the following six months.
  

While these are individual and infrequent cases, it’s also important to realize that deep tissue massage can potentially create these unintended consequences.

Does deep tissue massage release toxins?

Though some people believe that massage causes the release of toxins, specifically lactic acid, this is actually a myth because muscles don’t hold this acid for longer than 60 minutes.

Additionally, as far as other toxins are concerned, the body does a good job removing them on its own via internal organs or by “sweating them out.”

The only way that deep tissue massage helps with this process is by helping the body relax and rest so it can perform these other toxin-releasing functions.

Other than that, it really has no effect. Educating patients in regard to this can help clear up this rather common myth.

Protecting Yourself as an MT Giving Deep Tissue

Performing regular deep tissue sessions can be beneficial to the clients, yet not so beneficial for the practitioner.

Because they require a lot of hand and thumb work, extra precautions should be taken to better protect this area of the body.

Saving your hands and thumbs

“The number one thing therapists should do to protect themselves from injury is avoid doing too much work,” says Bykofsky. She also recommends not over-scheduling, working too many hours, or holding too many deep massage sessions a week. Also, take advantage of other “tools” at your disposal, such as different parts of your hands and arms, using them for leverage to take some of the pressure off your thumbs.

Everhart practices instrument-aided techniques to “allow for reduced stress and strain” on his hands while engaging in deep tissue massage sessions. Research published in the Journal of Exercise Rehabilitation reports that this can provide benefits to clients as well by improving their function and range of motion.


Practicing self-care

There are also other self-care practices that can make giving deep tissue massages more comfortable for massage therapists.

The first is to recognize if your particular technique is doing you more harm than good.

“If your hands and fingers start to scream while you're working, you need to modify what you're doing,” says Bykofsky. “Also, if you notice that you’re sore at the end of your work day, Bykofsky also recommends that you “do the things you suggest to your clients: ice, apply something to help, perhaps take an anti-inflammatory, and, the hard one, rest!”

Everhart adds that “proper body mechanics go a long way in protecting a massage therapist from injury.”

That’s why he recommends daily foam rolling.

Also, dexterity and range of motion exercises of the hand, wrist, and forearms “help to reduce stress on the smaller joints that often carry heavy loads,” he says.

Insurance considerations

It’s also important to consider purchasing massage insurance.

This offers massage therapists some type of financial protection in the event that, for whatever reason, they become no longer able to give regular massage sessions.

Some insurance policies are also designed to offer protection in the event that a client is somehow harmed during a deep tissue massage session.

Whether they suffer an allergic reaction to the lotion, cream, or oil or they have a previous health condition that is somehow aggravated during the massage session, having the right insurance policy in place can help cover the costs of an expensive lawsuit.


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