What is Deep Tissue?

When speaking of deep tissue massage we often find ourselves in a grey area, one in which our understanding of what that term actually means is unclear. This grey area extends from the client to the therapist, and creates a cloud of confusion around the whole practice. In order to work effectively in any modality, in order to use any tool effectively, one must know its purpose, otherwise we are just stabbing in the dark hopping that we accidentally hit something good. The real transformative effects of bodywork lie in intention, without some clear intention everything that occurs is just accident.

The first problem with the term -deep tissue massage- is that it contains the word- massage! Because of this people often associate it with other types of massage which have an entire different purpose. Swedish massage, which is the most popular massage modality we will encounter, is performed primarily for the purpose of relaxing and therapeutic touch. As this is the most common and basic massage modality taught and practiced in the west, it is usually assumed that the term deep tissue massage implies that is will simply be a relaxing massage with more pressure, or a” Hard” Swedish massage. This is where the communication breaks down. Deep tissue is performed for an entirely different purpose and can not be judged by the conditions that make for a good Swedish massage.

A more descriptive term for deep tissue is myofascial release. Myo= muscle, Fascial= Fascia or connective tissue. Call it what you will, this type of work is performed to improve structure and function, help address restriction and assist in the process of recovery. Deep tissue is not done for pleasure and certainly not done for relaxation, also it is not just a hard massage. We manipulate muscle and connective tissue, move bones, decompress joints and try to increase range of motion where it is compromised. Such sessions are considered by many practitioners as health care and not a “service”.

Thinking along these lines can completely change the interaction between clients and practitioner. As a deep tissue therapist, I care about what physical problems you are and have been experiencing. I care about your history of injuries, your subjective experience of pain and restriction, and your opinion about what you think might be part of the problem. I do not care about what you “like” or even what you “want”! Your goals are important, and your intentions for booking with a therapist are too. I will do my best to try to help you with my set of skills and my observations about what will be the most helpful. Think of it in terms of other health care professionals. Do you go to the chiropractor and say “I like it when you crack my back but I don’t like it when you do my neck.” “I like lots of feet” Do you go to acupuncture and tell the practitioner where to stick the needle?” Do you ask for more or less pressure from the osteopath? That brings us to one of the most important and misunderstood topics in deep tissue work, pressure.

As stated before, deep tissue is not just a hard massage, it is using the appropriate amount of pressure to address restrictions. This means we sink down to the first level of restriction we find and work there to lengthen or separate muscles and connective tissue. If the restriction is superficial, we stop and work there and don’t try to sink down to a deeper level until the level we are working releases. This type of work takes some sensitivity. Indiscriminately cranking on the pressure can not only cause unnecessary pain but even damage muscle tissue. Even though a well performed deep tissue session can be to some degree painful, it should be a releasing sort of pain and not an alarming sort of pain. It should in some sense feel good and that it is doing something meaningful. If a client is in so much pain they are tensing up and resisting, or they are exceedingly sore for a week after the session, it was too much. I usually mention to clients that they should be sore like they had a light work out, but not like they fell off a truck. If they are overly sore, the therapist should realize that they overworked the client and they should be more careful next time. It happens to all of use, but we need to learn from these experiences. I once heard a wise man say “appropriate use of force is not violence”. By that notion, the over use of force is violence. Rather than deep tissue, one might think of what we do a “appropriate level of depth tissue”.

Having addressed the topic of pressure, I feel it is important to address the topic of oil, and why a session that is purely deep tissue, or myofacial release does not include the use of oil, though many people are under the impression that it should. When doing structural work, we are aiming at lengthening or stretching muscle tissue that is short and tight. Also separating muscle groups that are stuck together. When using oil that is incorporated into the gliding strokes and friction of Swedish massage we can not perform this type of work. If we are slipping and sliding across the skin, we can not sink down and grab muscle tissue beneath, thus meaningful contact with muscle tissue is prevented by using oil. The therapist will wind up compressing muscle, even with oil and gliding strokes, but not grabbing and stretching. If the therapist can go beyond doing only compression to actively lengthening muscles, they are able to take this work to a whole new level. One of my instructors, Art Riggs, described this motion as “pulling taffy”. There are not many taffy machines around theses days, but maybe you get the idea.

Working with out oil can pull on the skin, and even feel like a rug burn. I will mention again that this work is not done for pleasure, so we don’t really care about that. When people go to a therapist for a massage, even a deep tissue massage, what we usually get is a mix of Swedish massage with some deep tissue techniques mixed in. This is because many of the therapist were actually taught deep tissue that way, and a good many of them have never had any deep tissue training and are just delivering a hard Swedish massage to clients who ask for it. Many massage instructors teaching deep tissue work received their training with all of these ideas and techniques mixed up with pampering massage methods as well. The fact is, these things usually come down to the students in a mixed up form already, and then continue to get more diluted as they are passed along, to the point where all intention and understanding of what they are doing and why they are doing it is very hazy.

I did not write this article to criticize therapists who mix deep tissue techniques with other modalities. People do often enjoy a therapist’s own personal synthesis of what they have learned and what they do, and hopefully that is why people will request them and continue to come see them. The problem is developing some understanding of what deep tissue actually is so that people have some idea about what they are signing up for. When doing deep tissue work, I would consistently encounter clients who were to some degree astonished by the work we were doing. They have never had anything like it before. Is this because I think my work is special? No, it is just that straight forward deep tissue work is not very common. People assume that because I am a Rolfer, and the deep tissue session was unlike anything they had experienced before that it must be Rolfing. This is not true, the client has probably never had a straight forward deep tissue massage before. People come in with all sorts of mixed up expectations. “I just want to relax, but my shoulder has been bothering me” “Well, which is it? Do you want help with your shoulder or do you want to relax? I can help you with your shoulder, you will need to go to someone else if you want them to help you relax”. Swedish massage, as all forms of relaxing massage can have many health benefits, boosting the immune system, lowering stress, even helping with chronic aches and pains, so I am not arguing over its usefulness, or the benefits of mixing those techniques with some structural work. I think it is important to know what you are signing up for though, no one coming to a deep tissue or myofacial release therapist should expect to be pampered! That is not the purpose or intention of this type of work. It is like going to McDonalds and then complaining that what you ordered is fast food. What is really needed here is education and public awareness.

John WilsonComment