“Do you do Deep Tissue?”

Yes? Maybe? Do I? It depends, actually. What do you consider “Deep Tissue”? Don’t get me wrong—I can use my elbow with the best of them. In fact, my husband calls me “Thunder Thumbs”—because he says that I can’t seem to massage him without hurting him. But I don’t buy into the idea that everyone should have Deep Tissue Massage. Please don’t misunderstand me—I am a believer in Deep Tissue! I just think that it’s important to get past “Deep Tissue” as a catchphrase and dive in to what it really means to be doing deep tissue therapeutic work.

There are really two schools of thought when it comes to Deep Tissue Massage. The first school of thought, which I (playfully) refer to as “Old School Deep Tissue”, is what most people seem to think of when they think of Deep Tissue work. “Old School Deep Tissue”-style massage therapists go in with deep (and sometimes REALLY deep) strokes, often without much warming of the muscle tissue. I have received deep tissue massage from therapists who start with the knuckles or elbows—but not all “Old School Deep Tissue” therapists are like this. Another mark of this type of massage is that it usually isn’t done with a lot of lubricant—be it lotion, cream, gel, or oil—because the therapist doesn’t need or want a lot of lubrication. This is because you don’t want to be slipping and sliding while applying this kind of deep pressure. You have to have some lubricant, after all—who wants a dry rub?—but it generally uses a LOT less than a Relaxation Massage. The theory behind this school of thought is that tight muscles are often full of adhesions—fibrous tissue developing from small tears in muscle tissue, tendons, or ligaments—and the therapist must apply great pressure to penetrate deep enough to reach these adhesions so they can release them.

The second school of thought on Deep Tissue Massage, or what I call “New School Deep Tissue” takes a different approach. Deep pressure is often applied to relax muscles—AFTER a warmup designed to relax the upper layers of tissue. These upper layers consist of fascia, bands and/or sheets of connective tissue under the skin that enclose and separate our muscles and internal organs. I like to describe “New School Deep Tissue” to my patients as peeling back the layers of an onion. The first layer of our “onion”, the superficial fascial layer, blends with and also lies just beneath the skin. The next layer, and the one massage therapists are most concerned with, is known as the deep fascia—dense fibrous connective tissue surrounding muscles, bones, nerves, and blood vessels. Below this deep fascia is the muscle itself. In “New School Deep Tissue”, the massage therapist usually begins the massage session with a modality such as Myofascial Release or Cupping (both of these using little to no lubricant) to release fascial restrictions, making it easier to get down to the muscle tissue below. The pressure for these opening modalities is not very deep, and patients often wonder if they are getting Deep Tissue Massage when the massage therapist does this. In fact, the whole point of doing “New School Deep Tissue” this way is to create the illusion that you’re not doing Deep Tissue at all. The “New School Deep Tissue” massage therapist usually does end up working with those knuckles, fists, and elbows—I have even used my KNEES when working with athletes—but when doing Deep Tissue this way, I greatly reduce the amount of pain experienced by most patients. Deep Tissue doesn’t have to be painful—in fact, I would argue that it isn’t supposed to be. I am very open about my preference for performing “New School Deep Tissue”—I believe that it is far more effective. I find that performing “Old School Deep Tissue” leaves me fighting against muscles that resist the onslaught of pressure. A lot of the time, the patient begins to “guard”, tensing their muscles (even if they don’t mean to) to resist when the pressure becomes painful. This requires much more effort for the therapist, because we are literally fighting with your muscles. I believe in working smarter—not harder—but I would be all for it if I saw that it yielded better results. I have seen far better results in my practice with “New School Deep Tissue” techniques. When you work your way into the muscles, you can tell exactly where areas of resistance lie. Oftentimes, you can work out adhesions in the upper levels that immediately relax the muscle tissue below. When I do work down to the muscle mass, I find that lingering trigger points are much more willing to release—and this gives me more time to do trigger point therapy in other areas. The majority of the work I do in my practice is geared toward pain relief. As a chronic pain sufferer myself, I want to relieve muscular pain with the least amount of discomfort possible. I feel that I am greatly reducing the amount of pain—along with risk for injury—by using this method. (Note: There are risks associated with receiving any kind of massage therapy. One example is for patients who suffer from blood clots. Deep Tissue Massage is not suitable for patients with blood clots, as they run the risk of dislodging clots. It is always best to discuss any medical conditions with your massage therapist prior to receiving massage. There are also risks for nerve damage and deep muscular bruising when massage is applied incorrectly. These risks are significantly reduced when pressure is applied responsibly.)

So, now that you know my affinity for “New School Deep Tissue”—what do I do when a patient comes in for “Old School Deep Tissue”? In all honesty, it depends on the circumstances. When a patient comes in to my office requesting Deep Tissue Massage, my first step is to find out what the term “Deep Tissue” means TO THEM. Are they expecting the massage to hurt? You would be surprised at the number of patients I see that fully expect for their massage to hurt. In fact, if the massage doesn’t hurt—some patients don’t think that it HELPS. I have noticed at times the first massage therapist we see sort of ‘trains us’—forming our beliefs about what massage therapy really is and should be. This becomes really hard when we can no longer see our original therapist. I work a lot with patients who are only in Highlands County for half the year, coming into the area to enjoy our milder winter temperatures. Many of these patients have a massage therapist back home. Often, they are looking for a massage therapist down here who is similar to their therapist back home. This is impossible because no two massage therapists are exactly the same. I can usually assess fairly early on when speaking to these patients if I am the right massage therapist for them, and one of the things I am looking to find out is if their massage therapist back home has a “no pain, no gain” sort of mentality. I am not a “no pain, no gain” kind of massage therapist. If I do not agree that pain-inducing massage is the best course of treatment for a patient—I am going to be honest about it. Translation-if I am not comfortable in my belief that going “ALL IN” is the best therapy for a patient-I am not going to do it. I will first explain WHY I do not agree with this method of treatment, offering an alternative treatment plan. If I do think that this patient is able to receive “Old School Deep Tissue”—I will also agree to perform it AFTER I have explained why I believe it would be more effective to go “New School”. Often I will try to find a compromise with my patients who buy into the “no pain, no gain” idea of massage therapy—suggesting that they try “New School” to see if it offers the same (or even better) results, and if it doesn’t—I will then offer to go “Old School” on them. HA! I have only had this happen a handful of times. Most of the time, the patient reports that they do find that “New School” helps—but they simply feel they prefer “Old School”. If I can give them what they want ethically—I am happy to do it.

I cannot stress enough the importance of discussing Deep Tissue with your therapist prior to receiving your first Deep Tissue Massage. As always, I invite you to contact me any time you have questions or want to discuss any of the topics I discuss on this blog further. Thank you so much for taking the time to read this blog.

—Stephanie

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