Summary: Deep tissue massage means different things to different people. In fact, it’s not a registered massage therapy technique at all, but a term that people who prefer firm pressure may use to express what they like in a massage experience. To this point, we all have our own preferences and responses to varying levels of pressure. When a massage feels good and doesn’t provoke bad pain, the nervous system can receive it as a safe and positive input.

Deep tissue massage is a term often advertised by massage therapy clinics. But it’s not an official technique. It’s not even taught in massage therapy school; and there’s no commonly accepted definition in scientific literature (Koren, 2017).

So what is deep tissue massage?

At best, it’s a phrase patients use to communicate that they prefer more pressure during a massage. At its worst, the therapy is marketed with false claims about magical effects. A quick online search reveals many of them: “weight loss”, “cleansing”, “removing harmful toxins from the body”, “eliminating pain” and curing every health condition under the sun. These bold claims simply aren’t true.

Pressure and massage

Every person is unique. And pressure preferences vary amongst individuals, different body areas and can even change from day to day. One person's idea of medium can feel deep for someone else. Clear communication with your RMT can help determine what type of pressure feels best for you.

“I’ve had chronic pain for years, and I used to get intense massages. I would often experience more pain and fatigue in the following days. My RMT and I decided to change strategies and try medium pressure. It felt more relaxing in the moment, and I felt way better after the massage. It turns out that less pressure helped my nervous system calm down more”. – Patient, Intent Health Clinic
“I find firm pressure is the most relaxing for me. I tune into my breath and feel like I’m just melting on the massage table. If there’s a spot that’s too tender, I ask my RMT for a bit less pressure. I feel amazing afterwards”. – Patient, Intent Health Clinic

Is a painful massage better for you?

First, let’s distinguish between good and bad pain. Good pain or therapeutic discomfort can be experienced when a sensation is getting stronger and approaching the edge of discomfort, but still feels good. Bad pain, on the other hand, crosses the line; it causes physical or emotional harm and can result in tissue damage with no positive effect. Firm pressure can be enjoyable and helpful for some folks, and inappropriate and harmful to others. Deeper pressure does not mean more effective.

What is deep tissue massage not doing?

✖️ Mechanically changing the structure of the tissue through force

✖️ Breaking up scar tissue, adhesions, trigger points or fascia

✖️ realigning muscle/tendon/ligament fibres back to “normal” form

How does deep tissue massage work then?

Like all massage therapy techniques: “A more probable explanation with supporting clinical evidence involves the nervous system, which is constantly adjusting muscle tension, movement patterns, perceptions, and pain sensitivity in response to new sensory information, including massage therapy, (and other social and environmental factors).” - The Glasgow School of Massage

There is compelling evidence that we cannot target specific or deep structures with massage because of the frictionless skin-fascia interface.
A study by Bereznick et al. concluded that because the skin-fascia interface is frictionless, one cannot direct force to a specific spot at a given angle by simply directing pressure in that direction.
“In soft tissue massage, for example, the practitioner will, in some instances, determine the direction of muscle fibres and then apply a stripping type motion to stretch the origin of that muscle away from its insertion. [...] Although the intent of these procedures seems rational, the findings of this study indicate that they cannot be accomplished due to the frictionless nature of the skin–fascia interface” Bereznick, 2002).

But if it hurts, it must be doing something good. Right?

We’ve heard this comment/question from people who don’t want a painful massage experience but have been told ‘no pain no gain’ or ‘it has to hurt to be effective’. Thankfully, this isn’t true. In fact, pain can activate our fight or flight response and exacerbate chronic pain and other health conditions. Enjoyable experiences that feel good, though, can help our nervous system shift into a calm rest and digest mode that supports healing. For some people that includes firmer pressure.

As with any massage therapy technique, be sure to communicate openly and honestly with your practitioner about your treatment goals and what types of pressure work best for you and on which areas of your body. Find a Vancouver RMT who is curious to work with you to find the techniques and levels of pressure that work best for your nervous system.

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How much pressure is too much?

Are you holding your breath? Grimacing? Even sweating? These are all signs that the pressure is too much. If you can breathe slowly in an expansive manner and feel yourself relaxing into the massage table, then you’ve found the right amount of pressure for your nervous system.