What is Deep-Tissue Massage?
By Anne Williams
This article first appeared in the January/February 2013 issue of Massage Bodywork.
The term deep-tissue massage is defined by different authors in different ways. Some say it is massage directed at the deeper myofascial structures of the body. Others ask, "What if the myofascial structures needing deep-tissue massage are superficial?" Some say that deep-tissue massage is work that feels deep to the client. Others ask, "Does this mean the work should feel painful to the client?" Some say the term is a misnomer and should be completely stricken from massage literature. Others say, "Wait a minute; our profession holds a general, not specific, definition of the term, and clients use it to describe the kind of massage they want." As you move from your massage and bodywork classrooms to your massage and bodywork clients, you may feel a little confused about this much-loved, much-hated, and much-debated term.
What I do know, personally, is that deep-tissue massage feels a certain way when I apply it. I think of it not as an independent massage system, but as a way to approach all soft-tissue structures, whether they are located superficially or deeply in the body. At any time, and during any type of massage, I want to be able to slow down and work more deeply when I encounter localized tension. Moreover, I am not just talking about pressure. I want to work more deeply with my thinking, with my listening, and with my whole self to facilitate therapeutic change.
Breaking Down Big Words
When I think about deep-tissue massage, concepts like thixotropy, viscoelasticity, piezoelectricity, adhesiveness, and tensegrity float around in my head. These concepts were introduced to the massage world by people with really big brains (e.g., Deane Juhan, Thomas Myers, Ida Rolf, Janet Travell), and even though I understand these concepts on a simpler level than the originators did, they inform my thinking about deep-tissue work.
You may remember the term thixotropy from a course on myofascial work. It is a phenomenon in which gels become more fluid when they are stirred up and more solid when they are left undisturbed. When it comes to connective tissue, especially fascia, the ground substance has the unique ability to move between a fluid, sol state to a viscous, gel state. Regular exercise, physical labor, stretching, proper hydration, and good nutrition promote a fluid, sol state in fascia. The heat created in the tissue by movement warms and stirs the ground substance. On the other hand, a sedentary lifestyle, poor hydration, poor nutrition, little physical movement, and tissue trauma related to injury cause the ground substance to cool, thicken, and enter a stiffened gel state, which can in turn lead to pain, decreased range of motion, patterns of tension in tissue that lead to postural imbalances, a greater risk for injury, and overall lethargy. The application of massage techniques that compress, lift, stretch, twist, and vibrate the tissue mechanically stir the ground substance and raise energy levels in the tissue, thereby reducing the possibility of these negative conditions.
Viscoelasticity is also a cool term. It can be broken down into the words viscous (thick, sticky, gummy) and elastic (expandable, flexible, stretchy). If a substance is viscous, it will become deformed, and remain deformed, when an outside force manipulates it. Imagine compressing a piece of clay with your fist. The clay will flatten and remain flattened. If a substance is elastic it will deform when manipulated by an outside force but snap back into its original shape when the outside force is removed (think of pulling and releasing a rubber band). Connective tissue is "plastic," whereas muscle is "elastic." When connective tissue is deformed by an outside force, like deep massage techniques or stretching, the tissue will remain in the deformed state after the outside force has been removed for a certain period of time, then slowly return to its original shape. This is why frequent massage and adaptations in movement patterns can lead to positive long-term changes in the shape and length of fascia.
Here's a term that's fun to say: piezoelectricity, which means "pressure electricity." It refers to the ability of living tissue to generate electrical potentials in response to mechanical deformation, including activities like dancing, running, walking or any other weight-bearing movement, or the manipulation of soft tissue or bone such as that which might occur during a massage or chiropractic session. Research has demonstrated that collagen, elastin, hyaluronic acid (found in connective tissue), keratin, and the actin and myosin in skeletal muscles exhibit piezoelectric properties.1 It is believed that these electrical potentials stir ground substance and improve the health of connective tissue. One common example is the use of electrical machines that simulate piezoelectricity and increase osteogenesis to speed the healing of fractures.2 Massage stimulates soft tissue in a positive way, leading to improved tissue health.3
Reducing fascial restrictions and adhesions in soft tissue so that functionally separate structures don't stick together is often a primary goal of deep-tissue massage. As people age, or because of habitual movement patterns, injury, lack of movement, poor postural habits, or soft-tissue stress, collagen fibers start to pack more tightly together, increasing hydrogen bonding between the fibers. This thickens and binds the tissue, causing decreased range of motion, postural imbalances, structural tension, and increased possibility for injury. In fact, two adjacent muscles or other structures that are designed to be functionally separate may become stuck to one another so that they don't slide freely. Many bodywork forms, including deep-tissue massage, help to break or prevent unnecessary hydrogen bonding to promote greater freedom in the myofascial network, which is always a good thing.
Tensegrity is a term coined by architect Richard Buckminster Fuller, and applied to the human body by Thomas Myers in his book Anatomy Trains. Fuller's architecture was based on a geometrical model where a structure maintains its integrity because of a balance of continuous tensile forces through the building.4 (Tensile forces refer to stretching forces, or tension, pulling at both ends of a structure.) In this model, muscles, tendons, and fascia provide the continuous tensile forces that maintain the upright structure of the skeleton against the forces of gravity and allow changes in tension to create movement.
Ida Rolf was the first to help us understand that when myofascial tension is balanced, the body is best able to disperse and effectively utilize the forces of gravity. If one set of muscles exerts tension in one direction, the opposing muscles must exert tension in the opposite direction or the structure may begin to bow and demonstrate postural misalignment. The two sets of tensile forces must be balanced for optimal function. Uneven tension places the entire structure under pressure and weakens it. Our primary goal then is to apply deep-tissue massage effectively so that the uneven pulls on the skeleton are corrected, and the body experiences greater ease of movement and less structural stress through muscular balance.
Now that we've thought deeply about deep-tissue massage, let's discuss some general application principles:
If Pain, No Gain. It is a common misconception that deep-tissue massage is painful to receive and that the pain must be endured so that the tissue can be forcefully elongated. When people experience pain, they contract their muscles to protect themselves. Elongation of tissue cannot be achieved if the client is bracing against the massage stroke.
Safety First. The client's overall condition and the medications she is taking may contraindicate deep-tissue methods. Review the client's health history carefully and use good critical thinking skills to determine if the client can benefit from deep-tissue massage.
Integrate Techniques. Before dropping into the deeper layers of the myofascia with deep-tissue methods, warm the tissue using lighter techniques and Swedish massage so that it is mobile and pliable. A session should never be composed entirely of deep work, as this could overwhelm the client's system. Clients who are overworked may feel nausea during or directly after the session, may experience headache during or directly after the session, and are likely to be sore and exhausted the next day. By integrating a number of different techniques, you ensure that the client's system can respond positively to the deep-tissue methods you use.
Be Present and Communicate Often. During the application of deep work you must remain present and responsive. You want to think about visualizing the tissue under your hands in order to attune to the tissue and recognize when it is inviting you deeper or when it is asking for more time.
Slow Down and Wait for Tissue Release. Deep-tissue massage is applied slowly with keen attention to the tissue and the way in which it is changing. Drop into the tissue and intend for the tissue to soften and release, and for your elbow, forearm, knuckles, reinforced fingers, or supported thumbs to progress through the fibers of the myofascia as the prow of a boat moves through water. If you are working at the correct depth and remaining responsive to the tissue, it will slowly start to open, and you will feel yourself melt into the tissue and advance.
Find the Therapeutic Edge. For every client, there is a particular pace and depth of deep-tissue manipulation that allows the greatest possibility of therapeutic change to occur in the tissue. The therapeutic edge could be defined as the place where the client feels the "good hurt," in which the client experiences some pain, but the pain feels right, appropriate, and good, accompanied by the feeling of tissues releasing and tension patterns diminishing. Work that is too light can feel disappointing and leave the client's tissue irritated because it was not engaged with enough depth. Work that is too deep causes a defensive resistance in the tissue and leaves the tissue feeling violated or invaded. If you have solid palpation skills, you are more likely to be able to find the optimal pace and depth for each individual client and work on the client's therapeutic edge.
Work in Layers. Avoid sporadically changing the depth of your work and jumping between layers of tissue during the application of deep-tissue methods. The nervous system can become overstimulated by such rapid changes, leaving the client restless or slightly irritated by the work. Instead, work in even patterns at progressively deeper layers as the client's tissue releases.
Work at Oblique Angles. In some situations, you might drop straight down into the tissue, but most often you will apply pressure at an angle no greater than 45 degrees. The use of oblique angles to apply pressure ensures that blood vessels, lymph vessels, and nerves won't be pinched against a bone. It also allows you to use your body weight effectively without undue stress on your joints.
Work Origins, Insertions, and Muscle Bellies. It is not uncommon for therapists right out of school to apply deep-tissue work to muscle bellies but avoid using it around the origin and insertion points of muscles. Many of these areas will require you to remain responsive to tissue changes and adjust your pressure accordingly, but so long as the client expresses no discomfort, work in these areas is valuable.
When Possible, Place Muscles in Lengthened Positions. It can also be helpful to place a muscle in a lengthened position before the application of deep-tissue work to facilitate the elongation of tissue. For example, you might rest the arm above the head in a slightly flexed position, supported by a pillow, while working on the triceps.
Use the Client's Breath. Remember that a client can support the release of adhered tissue with his or her breath. As a muscle is lengthened, as you move from the origin of a muscle to its insertion during a stroke, or as you move from distal body areas to proximal body areas, encourage the client to take a full breath and exhale as the stroke is performed.
Use Passive and Active Movement. Use passive movement as the last technique applied to each body area and active movement at the very end of the session. These techniques help alert proprioceptors that new movement patterns are available and are important in reaching and maintaining treatment goals.
While everyone may not agree on an exact definition of deep-tissue massage, we are all able to come to our own understanding of what it means to slow down and work deeply. As you consider these guiding principles, enjoy discovering how to modify and integrate them into your practice.
1. A.J. Banes et al., "Mechanical Forces and Signaling in Connective Tissue Cells," Current Opinion in Orthopedics 12, no. 5 (2001).
2. W. Hammer, "Piezoelectricity, A Healing Property of Soft Tissue," Dynamic Chiropractic, accessed December 2012, www.dynamicchiropractic.com/mpacms/dc/article.php?id=15481.
3. R. Turchaninov, "Research Massage Therapy, Part 2," Massage Bodywork, December/January 2001, page 48.
4. R.B. Fuller, "Tensegrity," accessed December 2012, www.rwgrayprojects.com/rbfnotes/fpapers/tensegrity/tenseg01.html.
Anne Williams is the director of education for Associated Bodywork Massage Professionals and author of Massage Mastery: from Student to Professional (Lippincott Williams Wilkins, 2012) and Spa Bodywork: A Guide for Massage Therapists (Lippincott Williams Wilkins, 2006). She can be reached at email@example.com.