Deep Tissue Massage: Pain is Not Gain

 

For every request I get of “I want deep pressure, as deep as you can. If it hurts, all the better!” I get at least two of “Well, I want to work out the knots but I don’t want it to hurt.”

There is a lot of confusion going around as to what deep tissue massage is; not only among clients but therapists as well. Somewhere along the line, deep tissue became all about jamming the pointy end of an elbow into a sensitive and overly tight spot with no warning or warm up, with the intent to cause pain, all in the name of gain.

I’m here to say: that’s not deep tissue… that’s a bad massage.

Generally speaking, most therapists will break out their deep tissue techniques when a client comes in reporting some kind of trauma, injury or repetitive motion that results in adhesions or damage to the connective tissue.

A good therapist, however, knows the secret to deep tissue: slow, often gentle work that is contingent upon listening closely to the body and moving on when you feel it soften or otherwise release. The goal is to create a parasympathetic response (rest and digest), because when the person is relaxed, the body can move easier into a state of homeostasis. This is where you find healing, and work that lasts beyond a day or two.

Saying it loud for the people in the back: If your “deep tissue massage” causes you to tense up and call for Mommy, it is not helping you.

There is a growing movement of therapists who have been doing research in pain and the nervous system. They are coming to believe that massage works with the nervous system in order to bring about change. When therapists apply deep, painful pressure they are activating something called “nocioceptors”: sensory nerves located deep in the body that serve as danger signals. They are preparing you for fight or flight, or a sympathetic response.

Clients are used to hearing “intensity is okay, pain is not,” otherwise known as the “hurts so good” variant. Many would argue that this is a tricky slide down the Pain Lane, still engaging in nocioceptor stimulation while simultaneously releasing endorphins, thus causing a temporary relief of discomfort. It unfortunately also causes a desensitization of the nervous system, which means that more and more pressure must be used with each consecutive treatment until only the painful stimulation is felt and misconstrued as relief.

Getting a client to check in with their own physicality is the first step to healing long before any kind of treatment. Are they aware of their postural issues? Can they communicate what they are feeling as you work together? Have they completely checked out of their own body so badly that even pain is no longer a stimulus? Knowing where your client is starting from is the first key to determining what kind of techniques are going to help them. In many cases, even intensity is not okay. I cannot count the number of times I had someone ask for deep tissue but be shocked when their body responded positively to the gentlest of effleurage.

This is what I tell each client asking for deep tissue:

I start at the top and I work my way down. That means, the pressure you feel at the beginning of the treatment will be firm but gentle. This lets us get to know each other. I will gradually increase the pressure and become more specific as your body warms up to the work. I only go as deep as your body will accept, meaning I work with your muscles and let them gently release in their own time. I will not force them. I will not work “to the pain.”

I have, unfortunately, had to start saying that last sentence as I will occasionally get a client who thinks that if it doesn’t hurt it doesn’t work. I will not provide that kind of massage. Not only is it beyond my physical capabilities, working that way can cause injury to myself and the client.

Deep tissue can be an effective tool in helping a body recover from injury or chronic issues. When done correctly, it can affect lasting change. It is not for everyone and it does come with its own set of contraindications, both physical and emotional/mental.

This is just a tiny, brief overview of Deep Tissue, my own personal beliefs about it, and some research out there. As always, I encourage each of you to do more research on your own and to come to me or your own professional with questions. This is honestly just the tip of the iceberg.

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Resources:
Werner, R. (1111). A Massage Therapist’s Guide to Pathology: 4th Edition. Wolters Kluwer/Lippincott Williams and Wilkins. P 18.

“Deep Tissue” Massage: How Much Pressure is too Much?. Massage St. Louis: Ask The Massage Therapist Blog, 2017. www.massage-stlouis.com/deep-tissue-massage-how-much-pressure-too-much

Shifting Away from Nocioception and Mesodermalism and Towards “Yesiception,” Neurocentrism and Pain Science. Massage St. Louis: Ask The Massage Therapist Blog, 2014.
www.massage-stlouis.com/shifting-away-nociception-and-mesodermalism-and-towards-yes-ciception-neurocentrism-and-pain-science

Lowe, Whitney. (2018). The Myth of the Pain Receptors. Academy of Clinical Massage. www.academyofclinicalmassage.com/myth-pain-receptors/