Occasionally I’ll have a client say something like, “You can give me as much pressure as you want. I can take it.” Every time I hear this, or something similar, I cringe! I wonder why it is that these people believe an effective deep tissue massage should hurt and leave them feeling bruised the next day. Massage should not hurt!
According to the National University of Health Sciences, the definition of deep tissue massage is this:
Deep tissue massage targets chronic tension in muscles that lie far below the body's surface. Deep muscle techniques involve slow strokes, direct pressure or friction movements that go across the muscle grain.
In the book Deep Tissue Massage by Riggs the general guidelines to applying deep tissue techniques are summarized as follows:
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.
It is a common misconception that deep tissue massage = intensity. There are times where a more intense pressure is appropriate; however, the intensity of the massage is not what defines deep tissue work and intensity does not relate to the effectiveness of the techniques, provided enough pressure is used to access the deeper layers of muscles. A skilled therapist with knowledge of anatomy can access and release these deeper layers without causing pain.
Not only is it not necessary, it is not effective and may cause more harm than good. Recently I have had a wave of new clients asking for “lots of pressure”. These clients have a few things in common:
· They all have what I would consider extreme, generalized tension in the upper back, neck, and shoulders.
· Many have made appointments with me because the therapists they had been seeing are taking time off due to injury.
Think of your muscles and muscle tension as someone from whom you want something. Let's say that you want your friend to pick you up from the airport. There are different ways you might try to reach your goal of getting that ride from the airport. You could tell your friend that they have to pick you up. You could demand, threaten, and bully. If they say no, you keep at it, demanding more and more aggressively, until they give in. Eventually, they might agree to do it, but this can cause tension between you. The next time you ask for something they might resist. You’ll have to push harder, threaten more, or be more persistent to get what you want from them. Each time this happens their guard goes up a little more. They might feel stress just by seeing you, anticipating a future attack.
Now, if you ask your friend nicely, maybe even offer to buy them lunch or pay for gas, they are much more likely to do what you want. Your relationship with your friend remains intact, and they are much less likely to raise barriers when you ask for help in the future.
Apply this same scenario to a different friend - your body. You want your body to relax and your muscle tension to release. You could bully your body, applying pressure so intense that the muscles become exhausted and finally give up and release.
The muscles will eventually release, but by applying intense pressure to the point of exhausted release you are training your muscles to be tighter, so they can withstand the pressure next time. Every time you do this, your muscles eventually relax but, when they recover, they tighten up even more, in preparation for the next “attack”. The end result is that you increase the general tension in your muscles, and it takes more and more pressure each time to get them to release.
Alternatively, a massage therapist can be specific, using just enough pressure, just the right techniques, at just the right spot to get release. With each release you can go into the next deeper layer of tissue without having to force your way through. The muscles relax and stay relaxed for longer, and without the rebound effect. The muscles learn to relax instead of learning to defend.
Another very important benefit of using finesse vs. force is that it is a more sustainable practice for the therapist. Even with proper techniques, good body mechanics, and lots of self- care practices, massage therapy is hard on a therapist’s body, particularly the hands, wrists, and shoulders. According to The American Massage Therapy Association, one of the top reasons massage therapists leave the profession is because they injure themselves from going too deep. Remember earlier when I said that my new clients were coming to me because their therapist was out for medical reasons – and all of these clients thought that the pressure needed to be intense to be effective? Perhaps this therapist used intense pressure on their clients and is no longer able to work because their body cannot take the physical stresses of this type of practice.
One more reason that massage therapists should favor moderate pressure most of the time: Intense pressure has the potential to cause damage. Intense pressure may cause bruising. Bruising is bleeding. I recently had a client tell me that that after a massage (by a different therapist) they were bruised the next day. They said this proudly, as if withstanding that was a desirable thing. We would never consider allowing a massage therapist to cut us, or otherwise cause external bleeding, so why would we think it’s beneficial, or even acceptable for them to cause internal bleeding? Too much pressure can cause the muscles to spasm, creating more pain and tension, initiating a pain-spasm cycle, and reducing blood flow which is critical to healing. In clients with osteoporosis or osteopenia it is even possible to break bones.
None of this is to say that there aren’t times where intense pressure, applied mindfully and specifically, within a client’s pain tolerance, and with an understanding of the anatomical structures being stressed isn’t appropriate. When applied using the criteria above, intense pressure deep tissue techniques can be very effective in breaking up scar tissue, releasing trigger points, and breaking the pain-spasm cycle. The key for the therapist is to know when the greater pressure is needed, and when less will be just as - if not more - effective.
As a client experiencing deep tissue work, you may expect that some of the techniques will be uncomfortable, even mildly painful. Only you know if it is a “good” pain or a “bad” pain, and when it becomes too much. If you feel yourself tensing up to brace yourself for the pressure, that might be an indication that the pressure is too much. If you feel sore after your massage or have bruises the next day, it might be too much. If you feel like the pressure is too much – speak up!
And be wary of any massage therapist who says you that they need to apply more pressure than you are comfortable with in order to have a therapeutic effect. This may indicate that they do not have the knowledge or training to apply deep tissue techniques safely.