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  • Margo Ann Spak Hemedinger, PT/LMT

Deep Tissue Massage

Time after time, a new client will come to me and request a deep tissue massage. Time after time, they tell me I am not going deep enough as soon as I start. Time after time, I ask if during their previous deep tissue massages, did they hurt from the time their therapist touched them, and if so, did they hurt for 2-3 days after. The response is always, ”yes!” Big surprise, right? How many of you have had this experience? I have, and I like deep work! But I don’t like to hurt from the minute my massage therapist touches me, let alone for 2 or 3 days after! Let me tell you a little story.

One of my first clients called me to schedule an appointment shortly after I opened my practice. He told me he used to get massages every month, but his massage therapist had started going too deep, and although he told her this, she persisted with the deeper pressure. He no longer enjoyed his massages, he hurt from the minute she touched him, and he hurt for 2-3 days after. So, he stopped going, and had not had a massage in almost a year. Since he saw that I was also a physical therapist, in addition to being a licensed massage therapist, and because I had been recommended to him by several people, he told me he was willing to try again, as long as I would only do a light massage. I assured him that I would abide by his wishes, and his massage would be guided by his feedback. So, he came in.

His first massage went very well. I used light to moderately light pressure and through his feedback, he was able to relax and enjoy his massage. He stated he felt good after his session, and he scheduled again for the following month, and began regular monthly visits. Now trusting me a little more, he became more relaxed with each session. He would tell me that he had been feeling good after his visits, and felt I could go a little deeper in his troublesome areas, each time I saw him. But around his 4th visit, I didn’t give my usual response of “OK, but let me know if I need to back off a little.” This time I said, “If I go any deeper, my elbow is going to be on the other side of the table!” His response? ”How come it doesn’t hurt?’ The answer? ”Because I took 20 minutes to get there!” And guess what? Nearly 10 years later, he is still coming to see me!

I could go on with many other similar stories, but there is no need. Regardless, the point is that deep work is not supposed to be painful. It can be uncomfortable at times, when the massage therapist is working on a tight and tender area, but a deep tissue massage should not hurt from the minute your therapist touches you. And although you may experience some minor soreness that may last a day or so from deep tissue work, you should not hurt for 2-3 days after.

Deep work is just that. Deep! To get there, you have to go through the superficial muscles and connective tissue (called fascia) first. There are 2 ways to do this: 1) To “break” through using force, or 2) To relax the superficial muscles and fascia, to allow the massage therapist to “ease” her way to the underlying structures without causing pain. Which would you rather have?

To me, this is just common sense. But many therapists were instructed in this older method to get into deeper tissues, and continue to do so today. This causes pain, and the body’s natural and reflexive response to pain is for the muscles to “guard” or tighten, to protect the body from more pain. So how can causing more pain, relax the muscles? It can’t. The muscles just tighten more causing more pain. This is called the pain cycle.

Simply put, the pain cycle is just what it says

it is. It is a cycle, and to decrease the pain, the cycle must be broken. The cycle starts with an initial injury or stress, causing some type of pain. The body responds by tightening the muscles around the area, called guarding, which limits motion, to protect the body from more pain. If this guarding is sustained over an extended period of time, the muscles will spasm, and /or develop trigger point areas (hyperirritable spots in the fascia surrounding skeletal muscle), which causes decreased blood flow to the area (ischemia), which in turn, causes more pain. Do you see how this can cycle can be never ending?

The pain cycle needs to be “broken” in order for you to feel relief. There are several ways the pain cycle can be addressed. Since I am a massage therapist, my discussion here will be limited to how massage therapy can be effective in breaking the pain cycle. Although this discussion is about deep tissue massage, please note that all massage is not deep work.

Swedish massage is the most common technique used during massage treatments. It generally utilizes a firm, but light to moderate pressure although deeper pressure may be used (which is different from deep tissue massage), to warm the muscles, increase circulation and to promote relaxation. It is used to work on large areas of the body, and it stimulates the parasympathetic nervous system to release hormones that “calm your nerves” thereby reducing anxiety, emotional and physical stress while promoting relaxation (parasympathetic state).

Deep tissue massage concentrates on more specific areas. As its name implies, deep pressure is involved in a very specific way using specific techniques to target the areas needing the deeper work. Indications for deep tissue massage may include (but is not limited to) chronic pain caused by one or more conditions, limited mobility, scar tissue and adhesions, muscle tension / spasms, and trigger points. It also aids in lowering blood pressure and decreasing stress, tension and anxiety.

Deep tissue massage should be done slowly to allow the superficial structures to relax, so deep work can be accomplished without significant pain. In doing so, one should start the massage with Swedish massage strokes, which will allow the body to respond by increasing blood flow, and warming the superficial muscles to relax, so deeper penetration into the underlying musculature and connective tissue (called fascia) can be achieved. Once the deeper layers of muscle and fascia are reached, specialized deep pressure techniques (circular friction, transverse friction, stripping) are now utilized to relax trigger points and areas of muscle spasms. This can cause some discomfort but should not be overly painful. When your pain tolerance is reached, it is very important at this point, that you tell your therapist to “lighten up” or “back off” a little, so your therapist can adjust the pressure. Otherwise, your body will naturally, and reflexively respond, by guarding and tightening those muscles again. Your session should end by changing back to the lighter and larger Swedish massage strokes. This change back to the lighter pressure will gently bring your body back to a “connected” feeling and out of the parasympathetic state.

Once your session is over, it is very important that you drink water. Many toxins are stored in those tight muscles causing the inflammation and tightness. Your deep tissue massage, has now relaxed those areas, and those toxins need to be flushed out of your system. If you don’t drink enough water to sufficiently rid your body of this metabolic waste, it will return to your muscles, causing muscle soreness, and much of what was accomplished during your massage session, will be negated.

I hope my discussion here, has introduced you to deep tissue massage, its indications, benefits, how it should be done, and its importance in the treatment of pain. Although I wrote this blog from many years of experience, and my knowledge as both a PT and LMT without the use of reference materials, the articles I have listed below, indicate much of the same information I have discussed. If you would like more in depth reading material regarding deep tissue massage, these articles will provide you with some additional information.

Thank you for visiting my website and reading The Blog Spot! Comments, questions and discussions are encouraged. Please feel free to post and I will respond when needed. See you next month!


The Benefits of a Deep Tissue Massage:

Deep Tissue Massage: Everything You Need to Know

4 Benefits of a Deep Tissue Massage

What is Deep Tissue Massage?

The Differences Between Deep Tissue Massage and Just Deep Pressure

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