April 25, 2012

A Word on Deep Tissue

“Deep tissue,” like most terms in the woolly world of massage therapy, has several meanings, none of them very precise.

 1) It's mostly commonly used in contrast to “relaxation” massage, or “fluffy spa massage.” Deep tissue is serious massage, massage that really does things, that digs in and finds problems and fixes them. It's not just petting. In this sense, it's really just a vague word of praise: it carries the same positive force – and carries about the same information load – as “real.” That was a deep tissue massage; a real massage.

 2) Its only reasonably precise meaning is also its most useless: it can mean “massage that reaches under the superficial muscles to reach tissues underneath.” All massage does this, of course; there's virtually no way to avoid it. And all competent massage therapists, however they advertise themselves, know how to move the body around so as to get better access to deeper muscles. A massage therapist who won't do this, who just pets an immobile body with a uniform light pressure, won't last a week. Even the supposedly fluffy relaxation therapists do this. Some are more aggressive than others, but they all do it.

 3) There are a variety of methods that advertise themselves as “deep tissue,” some patented and some not. These are particularly common among people who specialize in, and talk a lot about, fascia (connective tissue) and adhesions. They can get very excited about the thixotropic properties of fascia – how it softens as it is warmed and worked – and about how it can get stuck to things. Some of them talk a very persuasive line. Unfortunately when it comes to results, no one has been able to show that they are better at fixing anything than the supposedly fluffy relaxation therapists. (See my review of Cherkin's low back pain study, which directly pitted therapists trained in “deep tissue” against therapists who described themselves as doing relaxation massage. The relaxation therapists got slightly better results.) As for adhesions – as Paul Ingraham writes, “In active people . . . it is basically impossible to develop any significant adhesions, anywhere in the body.” People would love to believe that their bodily problems are simple mechanical ones, which can be fixed in the same way you'd fix a car – bang on this part, lube that one up, take this conglomeration apart and reassemble it, and voila, now your neck works fine! But attractive as this idea is, it's almost never that simple. The fact is that the verifiable effects of massage are rather mysterious and maddeningly unspecific. Massage makes you feel better, sometimes dramatically better, but it's very hard to say why.

Now having said this much, I have to make an embarrassing confession. I have, on occasion, advertised myself as a deep tissue massage therapist. I did this for a very simple reason. I myself like firm massage. I like a therapist who is not squeamish, and who will use enough pressure to really make a difference, when it's called for. I don't like to get manhandled or beat up, but I don't mind if there's occasional pain along the way, so long as I'm confident that my therapist knows what she's doing and won't really hurt me. Long before I trained as a massage therapist, as a client, I searched for therapists who would do that sort of massage, and I vaguely associated the term “deep tissue” with it. It was to tell my prospective clients that I could do that, if they wanted it, that I called myself skilled in “deep tissue” massage. (I have in fact studied fascial methods, pin and stretch techniques, various contract-and-relax protocols, so I wasn't just whistling Dixie. But I don't have a whole lot of faith in any of that stuff, as practiced by massage therapists.)

And the point here is that massage therapists can basically say whatever they want. It's very much a caveat emptor world: let the buyer beware. Someone who bills herself as a “deep tissue therapist” is probably one who isn't afraid to use a lot of pressure, which can be a good thing or a bad thing, depending on how sensitive her hands are and good she is at reading the body. But it doesn't tell you much more than that.


  1. This comment has been removed by a blog administrator.

  2. Very much agree.

    Can't wait to get past branding to "real" explanations :)

  3. Yes! There's so much to be learned, and verified. (Which is why I'm such a fan of the Massage Therapy Foundation:

  4. Well said. I say I do deep tissue mainly because people ask if I do it. Usually it's because they have been somewhere else and the pressure was much too light for them. It's one of the only things that works in favor of being a male therapist - clients think you must be stronger than females. That's not necessarily true either since most pressure comes from proper techniques.

    1. Women have greater strength in the lower half of their bodies and men in the upper half. As a woman the best thing I can do to increase the pressure of a massage is use my weight as leverage and even that sometimes seems not enough.

  5. Yes, I know I get some clients because I'm a burly (stout?) guy, and people think that means I'll use more pressure. Clearly, people who have never been beat up by one of those tiny Thai ladies :-)

  6. I find I do much better with a guy therapist, partly because of strength... Maybe the ladies are afraid they'll hurt me? I have had ONE lady I adored, left her behind in Colorado...

    Maybe it's the angles; tables are the same width, a taller, differently built body of a male reaches across the table in a different way...

    I know though that I've gotten better massages from males than females, by the numbers.


  7. Glad to hear it! It might just be the luck of the draw, but it might also be because it's a bit harder for male therapists to make it, so the ones who do might tend to be a bit better. I doubt it's really the strength or the build that makes the difference -- though you're right, I can put 150 lbs of weight on someone just by leaning over the table, whereas some of my colleagues would have to stand on you to do that.

  8. It's maddening to see spa owners who themselves are not trained in massage demand Deep Tissue from their therapists when what they are actually referring to is firmness of Swedish. The school where I did my training separated out Deep Tissue as a therapeutic elective discipline not part of the core (Swedish) training. Spa owners seem astonished to learn that I completed a 508 hr. certificate and do not offer Deep Tissue.

  9. I’m glad you posted something like this one.Great Blog!! That was amazing. Your thought processing is wonderful. The way you tell the thing is awesome. You are really a master.
    Deep Muscle Massage Therapy