Deep tissue massage is one of several dozens of massage therapy modalities practiced by licensed massage therapists. It is believed that massage therapy began as a sacred healing practice around 3000 BC or even earlier. In traditional Ayurvedic practices, five therapies are identified to create harmony and wellness including touch therapy, or massage. The other four therapies are diet, aromatherapy, color therapy, and sound therapy.
Shortly after Ayurvedic massage practice was born, other ancient cultures, including Chinese and Egyptian, began practicing touch therapy and massage. In fact, it is the ancient Egyptians who are credited with the development of reflexology around 2500 BC. In ancient texts, tomb paintings, and other forms of art, massage is often represented.
When Hippocrates came on the scene in ancient Greece, he referred to massage as The Art of Rubbing and prescribed “friction-based touch” to treat a wide range of physical injuries and ailments. The first Olympians even used massage to keep their bodies in peak physical condition before a competition and to relieve soreness after a competition.
Today, massage in the western world has evolved to include many of the original modalities of ancient cultures and the adaptations of new techniques. Each massage therapy modality has its own variety of pressing, rubbing, and manipulating the muscles and soft tissues. Today, licensed massage therapists use their hands, fingers, forearms, elbows, and even feet during a session.
Massage is used for a wide range of health conditions, including fibromyalgia, depression, anxiety, injuries, muscle tension, and even as complementary therapy for those undergoing cancer treatment. The type of massage you choose depends on the condition you are wanting to relieve and your long-term goals.
The nine most common types of massage practiced today include:
- Reflexology: A massage practice in which the therapist focuses on specific pressure points in the ears, feet, and hands. Reflexology is often used to help restore natural energy levels and is generally a relaxing massage.
- Sports massage: This type of massage is usually conducted to improve flexibility and reduce the risk of injury in athletes. However, a sports massage may also be helpful for those with a repetitive muscle injury like carpal tunnel syndrome.
- Swedish massage: Swedish massage is one of the more common types of massage therapy in the United States. The massage therapist uses a combination of soothing strokes and tapping strokes to relieve muscle tension.
- Aromatherapy massage: To increase the benefits of a massage, your massage therapist may mix essential oils into massage oil. Aromatherapy can help relieve muscle tension, depression, anxiety, and stress.
- Trigger point massage: This massage modality focuses on deep pressure in specific trigger points partnered with long relaxing strokes. Your massage therapist may use this technique to relieve muscle knots and certain types of chronic pain.
- Hot stone massage: Hot stone massages are often performed in spa environments, as they induce a sense of calm while easing muscle tension. Stones, about the size of the palm of your hand, are heated, and then placed in strategic areas to warm muscles and soft tissue. The massage therapist may rub them gently into sore areas to help improve blood flow and healing.
- Shiatsu massage: The goal of the Shiatsu massage is to help your body heal itself. A massage therapist uses her fingers, thumbs, and palms of the hands to apply pressure to facilitate greater energy flow.
- Cranial sacral therapy: This is a massage modality that focuses on the head, sacrum, and spinal column. Cranial sacral therapy can help treat headaches, chronic pain, and PTSD. In this practice, a massage therapist uses a very light and gentle touch; this is generally considered a very relaxing massage.
- Deep tissue massage: In a deep tissue massage, a massage therapist uses direct and firm pressure to target muscle soreness and soft tissue. This massage modality uses slow, deliberate strokes to help relieve chronic pain and chronic muscle problems.
What Is Deep Tissue Massage?
Deep tissue massage is one of the newer massage modalities. It was developed by Therese Pfrimmer in the 1940s to treat her leg paralysis. While trying to relieve her symptoms, Ms. Pfrimmer found that as she applied more pressure the muscles and tissues responded. After a period of time, she reversed her paralysis and went on to write the definitive book on deep tissue massage, Muscles Your Invisible Bonds, and to open the Pfrimmer Technique Deep Muscle Therapy School.
Deep tissue massage focuses on layers of muscles, tendons, ligaments, and other soft tissue, deep under the skin. A massage therapist identifies sore trouble spots and uses deliberate strokes and deep pressure. This type of massage focuses on aligning deeper layers of connective tissue and muscles that, when injured, can cause adhesions, limited range of motion, and poor circulation.
Chronic muscle tension or an injury can cause bands of rigid tissue around muscles, tendons, and ligaments. These adhesions can trigger inflammation, limit movement, block proper circulation, and cause pain. Deep tissue massage uses a similar pattern to Swedish massage. However, more pressure is applied to stimulate the deepest levels of soft tissue and muscles.
During a session, your massage therapist may combine strokes to lengthen the muscles, as well as cross-fiber strokes that may help free muscles from entrapment in the adhesions. Deep tissue massage is not classified as a relaxing massage. Rather, it’s deep work that can cause discomfort and pain.
Techniques of Deep Tissue Massage
When you have a deep tissue massage, your massage therapist may employ a variety of techniques to relieve pain and facilitate muscle healing. Here are six techniques that may be used.
1. Myofascial Release
As part of a deep tissue massage, myofascial release involves gentle but sustained pressure in the connective tissue. It is done to help restore motion and relieve pain. Your massage therapist will locate areas that are stiff and fixed, instead of moveable and elastic. Then, your therapist will target them with pressure to improve movement in your muscles and joints.
2. Cross-fiber Work/Friction Massage
Friction massage is what Hippocrates prescribed, and in a deep tissue massage session, the friction is applied in areas that are tight and prone to scar tissue. Cross-fiber work is used for treating soft-tissue injuries, and as such can be painful. If the pain becomes too much, or you are holding your breath, speak up, and your therapist will make the necessary adjustments.
3. Breath Work
During a massage, your therapist may help guide you in breathing. It is imperative that you don’t hold your breath during a massage, even for short periods of time. Your body needs oxygen moving freely during a massage. And deep breathing may help you to relax through more painful areas.
4. Positional Release
If your massage therapist is having a difficult time getting your muscles to release, they may position you in a comfortable pose to shorten the tissue and muscles. In some cases, positional release can trigger the muscles to relax and release.
5. Trigger Point Therapy
As part of a deep tissue massage, your therapist will likely apply deep and persistent pressure on sensitive spots and muscle “knots.” This can include rubbing and pressing on pressure points. In some cases, the therapist may use the knuckles or even their elbows to reach large tissue deep under the skin.
6. Range of Motion
If you are having a deep tissue massage due to a frozen shoulder, neck, carpal tunnel pain, or stiff knees or calves, your massage therapist may gently move or rock the affected joint. This is not a jerky, chiropractic-like movement. This is a slow, deliberate movement to help loosen muscles and facilitate a better range of motion.
11 Deep Tissue Massage Benefits
All modalities of massage offer certain health benefits. Human-to-human touch is healing, both physically and emotionally. Deep tissue massage is different in many ways, primarily because of the depth of the work. Medical researchers have found deep tissue massage benefits functions in the body beyond muscle pain and relaxation. Let’s discuss a few of the research-backed benefits of deep tissue massage.
1. Lowering High Blood Pressure
Yes, deep tissue massage can lower high blood pressure and decrease your heart rate according to a study published in the Journal of Alternative and Complementary Medicine. In this study, researchers found that a 45-60 minute deep tissue massage in patients with muscle strains resulted in a systolic pressure reduction of 10.4 and a diastolic pressure reduction of 5.3. The authors of the study urge further investigation to determine the long-term benefits of deep tissue massage for individuals with high blood pressure.
2. Reducing Muscle Tension
If your typical day has you sitting at a desk or standing on your feet, or you’ve recently been injured, a deep tissue massage may help relieve muscle tension. It is so common to have tight and sore hamstrings, glutei, IT bands, rhomboids, upper back, shoulders, and neck, in part because of our lifestyles. Deep tissue massage can help improve range of motion and flexibility, as well as encourage healing of injured muscles and connective tissues.
3. Reducing Stress and Anxiety
Chronic stress and anxiety are reaching near epidemic levels according to some healthcare professionals. When we are stressed, our body releases the hormone cortisol, causing weight gain, muscle weakness, bruising, and even diabetes. Fortunately, researchers have found that deep tissue massage increases oxytocin levels, serotonin levels, and endorphins. These hormones are essential for happiness, well-being, and healthy relationships. Human-to-human contact also helps us feel more connected and relaxed.
4. Improving Lung Function
In a 2017 landmark study published in the International Journal of Chronic Obstructive Pulmonary Disease, researchers found that massage has an immediate effect on oxygen levels for those with severe or very severe COPD. In the study, researchers stated that massage demonstrates “Immediate clinically meaningful improvements in lung function” with Sp02 levels increasing from an average of 93% to 96%. The authors of the study encourage further research to determine the full potential of massage on lung function and those with COPD.
5. Improving Athletic Recovery
Massage therapy, including deep tissue massage, slows the activity of inflammatory cytokines that contribute to pain and inflammation after a workout or competition. Researchers from the University of Illinois at Chicago have found that massage therapy helps to increase protein levels associated with the production of mitochondria. This chemical reaction can help facilitate muscle recovery and healing after injury and activity. Researchers state that massage can improve circulation and alleviate soreness after exercise.
6. Improving Flexibility in the Spine
A recent study published in the journal Evidence Based Complementary and Alternative Medicine found that deep tissue massage and therapeutic massage can improve spine flexibility for men with a rare condition called ankylosing spondylitis. In this small randomized clinical pilot study, each participant had 10 massage sessions—either deep tissue massage or therapeutic massage. Both groups experienced benefits, including improved flexibility and reduced pain intensity of the lower back.
7. Relieving Chronic Low Back Pain
Chronic low back pain affects millions of people each year in the United States. The persistent pain can be debilitating and adversely affect quality of life factors. Fortunately, according to a randomized single-blind trial, researchers have identified that deep tissue massage reduces pain equal to the combined use of deep tissue massage and non-steroid anti-inflammatory drug (NSAID) use.
8. Easing Fibromyalgia Symptoms
Fibromyalgia symptoms can cause debilitating pain, stiffness, depression, and anxiety. Research shows that deep tissue massage can be an effective natural remedy for fibromyalgia. Studies show massage eases pain, anxiety, and depression in individuals with fibromyalgia.
The systematic review published in the journal PLOS One found that weekly massage therapy, longer than five weeks, had an immediate benefit on improving fibromyalgia symptoms. If you have fibromyalgia, it is important to find a licensed massage therapist who understands this autoimmune disease and has extensive experience treating it.
9. Increasing Joint Mobility
As we age, join mobility decreases. For those who sit at a desk all day, this can happen sooner, rather than later. In a meta-analysis of clinical studies published in the Journal of Physical Therapy Science, researchers note that massage is effective at improving shoulder flexion and abduction, thereby improving range of motion. Researchers of this meta-analysis reviewed seven clinical studies and concluded that deep tissue massage can improve joint mobility. They urge extensive randomized controlled trials to determine the beneficial role of massage in joint health.
10. Relieving Chronic Pain
In an effort to fight the opioid crisis in the U.S., researchers are investigating massage therapy’s ability to relieve chronic pain. In 2018, the American Massage Therapy Association published a report titled “Massage Therapy in Integrative Care & Pain Management” that highlighted the latest studies showing how massage relieves chronic pain. This research supports the use of massage in chronic pain management as adjuvant therapy instead of prescription opioid painkillers. The researchers hypothesize that massage therapy could eliminate the possibility of opioid addiction in certain groups with chronic pain.
11. Promoting Sleep
Insomnia is a growing problem in the United States. Lifestyle, stress, anxiety, and a lack of exercise all contribute to poor sleep. Now, researchers have found that deep tissue massage can help improve sleep quality by reducing cortisol levels and lowering blood pressure and heart rate. The study, published in the journal Sleep Science, was conducted on post-menopausal women with diagnosed insomnia. Researchers relay that massage therapy could be beneficial for menopausal symptoms, particularly insomnia.
Deep tissue massage side effects can occur. This massage modality is not appropriate for everyone, including individuals:
- Diagnosed with blood clots as it can dislodge clots.
- Undergoing cancer treatments including radiation and chemotherapy—talk to your oncologist and massage therapist about appropriate massage therapy modalities.
- Recovering from surgery.
- Diagnosed with severe osteoporosis.
Deep tissue work is a combination of science and art. It is important to find a licensed massage therapist with the education and relevant experience for your condition. Search the American Massage Therapy Association’s database to find a provider near you.
What to Expect During a Deep Tissue Massage
Your massage therapist should be up-to-date on your medical history and any medical conditions you may have. He or she should also be aware of any type of pain or discomfort you are feeling. When describing your current discomfort, be as specific as possible. Is the pain sharp? Is it stabbing? Does it radiate? Are you experiencing any numbness?
It is also helpful for your massage therapist to understand how you spend your days, the exercise you do, and the level of stress you live with.
Remember, deep tissue massages aren’t relaxing—they are therapeutic and designed to rehabilitate your muscles and soft tissues. If you want a purely relaxing massage, you may prefer to opt for a Swedish massage or hot stone massage.
A wise massage therapist once said, “You need a balance. You need ‘extended lotion applications’ for your mental health and deep tissue work for your physical body.”
During a deep tissue massage, expect some level of discomfort. This is normal as your massage therapist will be targeting the areas that need the most work. Deep tissue massage technique calls for moving against the muscles and soft tissue, rather than with them—this is the source of the pain.
Be sure to voice your discomfort so that your therapist can adapt to your personal pain threshold. It is vital that you remember to breathe, even through the pain. Holding your breath in a massage is counterproductive, and works against your therapist.
Immediately after your massage, drink water—more than you think you need. Deep tissue massages release lactic acid, and the quicker you can flush it out, the less soreness you’ll experience in the coming days.
Bruising is rare, but can occur. When you return for another deep tissue massage, be sure to tell your massage therapist you experienced bruising as a result of the last session.