There is much confusion in the industry to the differences between Deep Tissue and Deep Pressure.

Mainly, when a client requests Deep Tissue, they are actually seeking a Deep Pressure Massage which is exactly how it sounds – an overall massage which combines forearms, elbows, fists, knuckles and thumbs – and pressure!

Deep Tissue massage also utilizes the forearms, elbows, knuckles, fists and thumbs, but the differences between the two approaches are vast.

Deep Tissue, as it is known generically, includes the use of techniques and theories developed by Ida Rolf and has been integrated with other approaches to massage.

Deep Tissue is a technique of massage that focuses on “deliberate intention” and utilizes slow gliding movements which encourage the unfolding or unwinding of tissue.

The “approach” is “focused”,  working slowly from superficial to deep fascia, recognizing areas of resistance, working (and waiting) on these specific areas before moving on. The technique takes time and the patience of both the client and therapists.

The appropriateness of staying and working on an area or moving on will depend on several factors such as:

Tissue Response

Client Pain-Threshold

Therapists Comfort Level

Time Available

Tissue resistance to lengthening and elongating can be found in all layers of fascia. The reasons behind chronic contraction and pain are many and varies.

The Deep Tissue approach is to:

1. Apply enough pressure to engage or meet the resistance (not overpower it)

2. Sustain the pressure against the resistance moving into the direction of the resistance until;

The resistance diminishes

It is time to move on

The application of this treatment should remain within the “clients’ threshold of pain”. Some discomfort may be experienced during these sessions, but, if the LMT responds accordingly, discomfort should lessen/cease in a short period of time.

Suggested LMT responses  to client discomfort

A slight decrease in pressure. Pressure gauges should be set with your client in order to determine the depth of your pressure. A pressure gauge of 1 – 5 (1 being very light, 3 being perfect, 5 being too deep) will allow you the opportunity to “back-off” or “slowly proceed”.

It’s important to keep in mind that most of your movements should be slow and small, based on intention (having a goal), sensitivity (seeing with your fingertips, watching/listening to the body) taking directions from the tissue, awareness (remaining open and accepting of what you’re discovering). It’s important to listen to what the body and spirit have to say.

A slight change in the direction of your pressure. By changing your body mechanics (leaning back or forward, bending your knees, shifting your stance, moving your fingertips from points to pads, shifting your foot, etc.) will change the quality of your touch (soft, less invasive to deeper, a bit more forward moving) and the direction of your touch. There should be no quick movements, dramatic changes in direction or pressure or quick movements in/out of the tissue.

A shortening of the structure you are working on. By bringing the origin and insertion closer together, you will create a shortening of the structure or slacking in the tissue. This will decrease the resistance of the muscles at the level you are working, allowing you to move deeper into the fascia or the “tissue that binds”. Use pillow bolsters or rolled up towels to support the shortened structure. This technique may be used in conjunction with direct pressure, relax/contract techniques or breathing in order to increase the results.

A slight lengthening of the structure that you are working on. By moving the origin and insertion of the muscle away from each other, you will create a lengthening or a “tightening of the tissue”. This will increase the resistance that you are working with which may assist you in releasing contraction. This technique may be used in conjunction with direct pressure, relax/contract technique or breathing in order to increase results.

Instructing the client to focus their breath “into the structure” or settle into their body. This will assist the client in shifting their focus (from what you are doing) to their own body. It allows the client the opportunity to participate in the treatment. Also, a deep breath will assist in the release of tissue.

Contract/Relax Technique. The client creates tension or contraction within the muscle(s) you are working on. This can be achieved by the client contracting the muscle without assistance (isometric contraction) or with the aid of resistance (resisted ROM) to the muscle in order to achieve contraction.

Fomentation, Hydrotherapy. Using the application of hot, moist heat to create an expansion in the tissue (when no inflammation is present).

Return to work on the area at a different time. Tissue will decide when it’s ready to release, not the LMT. People hold onto contraction, pain, illness and disease for a variety of reasons. When the time comes to shift, soften, let go, the body will respond.

Remember, the tissue should not be forced to painful excess, but encouraged to release. If you don’t get anticipated results “let go of your expectations” and move on. There is always another time to try again.

“Three D’s” of Deep Tissue Application

Direction of pressure is determined by the direction of resistance of the structure

Depth is determined by the level of tissue to be treated and the amount of pressure required to engage the resistance of the tissue

Duration is determined by the rate of release in the tissue or the conscious understanding of “letting go and moving on”

Benefits of Deep Tissue

1. Free the connective tissue from a contracted state to one of elasticity
2. To free tissue from restricted fascia formations which distort posture or limit ROM
3. Assists in the realigning of posture and re-establishing independent muscle action
4. Re-establishes circulation and reduces tension in chronically contracted muscles
5. Reduces pain

Contraindications

Any contraindication to massage is a contraindication to Deep Tissue. Generally, Deep Tissue is indicated for chronic contraction or Chronic Holding Patterns where there is no evidence of pathology or injury. Deep Tissue should never be applied in the acute stage of injury or if inflammation is present.

Chronic or Remodeling Stage (Last Stage Of Healing)

Long Term Signs and Symptoms

1. No visible signs of inflammation
2. Scar tissue has developed and is maturing and shrinking in accordance to stresses placed on injured area.
3. General muscle weakness
4. Pain is felt with stretch, past the available ROM
5. Chronic and re-occurring pain ranging from mild to severe
6. Decrease in ROM (Range of Motion) and LOF (Loss of Function)
7. Postural Imbalances
8. Muscle Guarding
9. Chronic Holding Patterns

Duration: 4 days>

Treatment Goals:

1. Decrease pain
2. Increase ROM
3. Increase muscle strength and function
4. Re-align scar tissue

Treatments

1. Hydrotherapy: Ice & heat or ice (alone) or heat (alone) depending on inflammation
2. Massage: All types, esp. DT, Frictions, CFF (at site to re-align scar tissue/increase circulation)
3. Muscle Energy Technique or Proprioceptor Neuromuscular Facilitation to reduce spasm, re-educate muscle function and increase muscle strength
4. Active>Passive>Resisted ROM to maintain or increase mobility
5. Stretching to lengthen muscles

Notes on Chronic Stage

1. Scar tissue has developed and is maturing/shrinking according to stresses placed up it
2. Collagen fibers shrink, pulling and torqueing all structures it has adhered itself to
3. If appropriate treatment is followed, treatment can progress with greater intensity until function is restored

Effects of Scar Tissue

Scar tissue needs to be re-aligned in a way that allows normal functioning of a muscle during contraction and lengthening.

When injury occurs, scar tissue forms “like pick-up sticks”, every conceivable way – which limits muscle broadening and causes uneven tension in surrounding muscle tissue. This leads to further tissue damage.

Areas Most Affected in the Muscle

In the muscle belly, there is usually enough area for broadening and lengthening to occur. At the musculo-tendinous junctions, less broadening/lengthening occurs and less healing takes place. These are areas that need further stimulation. 

Physiology of Pain

The network of nerves branch off and break down into tiny nerve ending fibers. At the end of these fibers are three types of specialized nerve endings which respond to stimuli; pain, touch/pleasure and thermal. Touch/pleasure and thermal fibers are much larger and arranged more densely throughout the body. Therefore, sensations of touch/thermal travel quicker to the brain and over-ride the pain receptors.

Pathways of Pain

Pain messages are sent to the brain via nerve fibers to the spinal cord, up the cord to the center of the brain (thalamus). The message then becomes more defined, adding emotional components from the cerebral cortex. Since the brain can only send one message at a time, the pain is either altered by overriding the sensations (touch/temperature) or the pain is felt at full force. This “switching” on/off from pain is known as the “Gate Theory”.

Sol and Gel States

Massage influences pain stimulation and proprioception. Physical removal of waste is achieved by muscle kneading which increases the circulation. This allows oxygen, nutrients and blood to replace the toxic buildup and reduce the chemical neurostimulators which irritate nerve endings.

The fascia which encases the muscles and fibers vary from a thin liquid state (sol) to a thick and solid state (gel). The consistency of the fascia substance can be influenced by heat and friction. When the muscle becomes warm from an increase in blood flow; various massage strokes, stretching, yoga, hot packs, and etc. the fascia becomes more supple and pliable. The physical pressure (pulling, tugging, stress) of the muscle itself and on surrounding fascia bones, lessens. In a “sol” state, the muscle lengthens, decreasing joint and muscle pressure, which reduces the neurostimulating input into the spinal cord.

As we are touched, the brain may release chemicals which act as pain inhibitors such as kephalin or serotonin, vasoconstrictors which are believed to inhibit a nerve from firing to the next nerve, reducing or eliminating the pain response. Other chemicals such as endorphins product opiate like substances, increasing the pain threshold.

Conclusion

Deep Tissue application is an “art” – not a magic trick. Anyone can learn the art of Deep Tissue application with time and practice. Moving slowly with intention are the basics of Deep Tissue massage. With patience and the “willingness of letting go of expectations”, tissue will unwind, unfold and dance under your fingertips!

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