Deep Tissue Massage: Benefits, Pain Relief, Recovery, and When It's Right for You
It is not uncommon as a massage therapist who works with active people and athletes to have requests for deep tissue massage. Many people seek deep tissue massage benefits ranging from chronic pain relief to improved athletic recovery. What is not understood is how deeper tissue work typically evolves as a session unfolds. Deep tissue work is not simply analogous to harder pressure, and for some, getting deeper into the tissue necessitates a substantial amount of myofascial work to help the muscle layers and connective tissue to begin to relax. Here, we look at what deep tissue massage is, and what it isn’t, and how it can be helpful for many people when correctly applied.
What Is Deep Tissue Massage?
How Deep Tissue Massage Works. Deep tissue massage, as mentioned, involves working through layers of muscle and fascia to get to deeper muscle groups and layers even within more superficial muscles. Therefor, it is necessary to essentially “warm up” the superficial tissue with more classic slow effleurage and petrissage strokes (key techniques within Swedish massage). In some individuals, fascial layers can be very tight and thus myofascial work, or myofascial release (the massage technique of stretching or pulling on the skin and connective tissue for prolonged periods of time) is necessary to get the body to release tension and fascia restrictions which otherwise prevent access to the deeper muscle layers. It is necessary to address this chronic tension held in the tissue for the body to even accept deeper muscle work and to alleviate or prevent pain that can occur from simply starting a session with deep sustained focal pressure.
Deep Tissue Massage vs. Swedish Massage. Compared to Swedish massage, where the techniques and strokes can be traced back to the 1800s and specific founders, Henrik Ling and Johan Georg Mezger, deep tissue massage evolved in the 20th century. Some of its strokes came from James Cyriax who developed deeper frictional strokes for working with scar tissue while other aspects of it were influenced by the work of Ida Rolf, the founder of Rolfing, and other influential massage therapists at that time who were integrating deeper, sustained pressure strokes into their classic, or Swedish, massage sessions.
Deeper tissue work, because of its nature, can have a greater impact on adhesions, trigger points, and scar tissue, mobilizing muscles and tissues of the body which may be perceived as “stuck”. It is not uncommon for very tight muscles and fascia to almost feel like bone – it is in these regions that deep tissue massage may be indicated. But when freeing up the muscle and breaking down the adhesions, an inflammatory response associated with cellular damage may be triggered. This is one reason why it is key to utilize deep tissue massage only when appropriate, as to avoid provoking unnecessary pain and delayed onset muscle soreness. It also is why the deeper tissue work is integrated within classic strokes of a Swedish massage session, as more superficial work is helpful to move the byproducts of breaking down adhesions within the tissues.
Benefits of Deep Tissue Massage
Relieve Chronic Muscle Tension. Many, many people hold tension in their shoulders and necks. These painful areas are often described as muscle knots, although they typically represent regions of increased muscle tone and trigger points. A key place where trigger points often can be found is in the region between the neck and shoulder, where the upper trapezius and levator scapula reside. People who spend a lot of their time on computers, or in similar postures such as driving, commonly experience this as a region of pain or tension. The lower back and hips are also locations where this type of chronic muscle tension can be held and may benefit from deeper tissue work. Deep tissue massage can be particularly effective for reducing this type of chronic muscle tension that develops from repetitive postures, prolonged sitting, or physically demanding activities.
Improved Mobility and Flexibility. When there is deep muscle tension, there also often is restricted movement. When trigger points and adhesions exist in the shoulder as described, one will frequently experience limited movement in shoulder abduction (moving the upper arm away from the body) or difficulty being able to fully reach behind their back. Scar tissue, from surgeries or injuries, also can be slowly broken down over time with deep tissue massage, restoring the muscle and fascia to a healthier state and bringing increased range of motion along with this.
Supports Better Posture. Along with the reduction of chronic muscle tension and restricted range of motion, posture also can be improved. However, this does not come without some effort and awareness – our postural patterns are often deeply ingrained and can be partly psychological in nature as well. Many of us are not taught to hold our head up high and pull our shoulders back when we encounter the world – we are much more likely to have our head down and shoulders rounded. Electronic devices only exacerbate this as we spend much of our time looking down at a phone or a laptop.
Massage for Athletes and Active Lifestyles
In the Gorge, so many of us are athletes and actively engage in many sports on a daily basis – often, without putting much attention into recovery. This can work for a time, but eventually, those muscles that have been doing overtime on the river, ski slopes, or hiking and biking trails can come back to haunt us. Often, we see people at Gorge Naturopathic and Massage who have muscles so tight that it takes a substantial amount of time to start to get into the deeper tissue work. Many are dealing with longstanding fascia restrictions and chronic overuse patterns that require gradual release rather than simply applying more pressure.
One thing many may not realize is that massage not only “feels” good, but it also has therapeutic benefits that have been shown in clinical studies. Both deep and more superficial massage have been shown to reduce markers of inflammation and muscle damage in young athletes after strenuous exercise (volleyball), with no significant difference between the two techniques. Deep tissue massage has also been shown to help alleviate delayed onset muscle soreness in individuals weight training as a part of their training program and muscle pain after an exercise session. Deep tissue massage can help reduce blood pressure and heart rate increases that may accompany moderate to severe pain related to muscle spasm and strain.
Not only does massage help with these aspects of post-workout discomfort, it also can help enhance training. In athletes receiving massages biweekly for 8 weeks through their training program, deep tissue massage improved flexibility, strength, and other recovery outcomes. Joint mobility and strength were especially improved in the shoulder, lumbar region, and knee with this intervention. On a cellular basis, massage also has been shown to increase mitochondria biogenesis – essentially increasing the development of new cellular energy powerhouses.
Does a Deep Tissue Massage Hurt?
At Gorge Naturopathic and Massage we pay attention to any signals of pain – flinching, sweating, muscle twitching, increased redness – and know to approach a region cautiously and slowly when these potential symptoms of pain or tissue release are present. We also check in with the individual receiving massage as pressure is increased in regions of muscle tension when moving into deeper tissue work.
When approached correctly, deep tissue massage may cause transient local sensations of pain, however, pain shouldn’t be prolonged. Releasing longstanding muscle knots or trigger points may create temporary discomfort, but the goal is always lasting improvement—not excessive pain. Pain can be experienced because the deep tissue work breaks up adhesions and regions of focal muscle hypertonicity – essentially, the muscle fibers are unable to relax, and deep tissue work can help to resolve this issue. Hence, it can play a major role in chronic pain relief, releasing trigger points, even though there may be mild pain during this part of the session. Mild soreness may be experienced in the 24 hours after deeper tissue work, but gentle self-massage and topical application of anti-inflammatories can help. Pain should never feel unbearable, and it is important to communicate whenever there are regions where this deeper tissue work is not preferred.
When Deep Tissue Massage Is Not the Right Choice
Post-Injury, Surgery, and Aging. There are certain times when deep tissue massage may not be appropriate. One example is in the early days after an injury as the tissue has been damaged and is already actively engaging in the “clean-up” phase and cellular repair. Acute muscle tears, sprains, or regions with significant bruising would be places to avoid deeper tissue work. Similarly, after a surgery, it is important that tissues are not stressed with deep massage strokes as the body is actively healing and essentially “sewing” up the damage with its first pass at healing (which often is a source of scar tissue, to be addressed later when the acute phases have passed). In elderly or frail, deep tissue massage also may not be appropriate due to the body’s slowing down of repair mechanisms with time. However, on a case-by-case basis it can be considered when appropriate.
Active Infection, Clotting Disorders or Medications, and Cancer. Certain medical conditions also are contraindications to deep tissue massage. Active infections, particularly when accompanied by fever, a sign that the body is busy addressing existing inflammation, are a contraindication for deep tissue work in the body overall. Clotting disorders, or medications which treat them such as anti-coagulants, are also situations when deeper tissue work should be approached with caution and perhaps avoided. Finally, cancer, which also can predispose the body to blood clots in some settings, is a setting in which deep tissue work may be contraindicated and not take place without physician clearance. Generally, deep tissue work in this setting may be acceptable in other regions of the body which are not in the vicinity of known solid tumors, but not in the region where there is a known cancer.
Sometimes a Gentler Approach Is Better. In many of these settings, a gentler approach or waiting until the body is no longer in an acute recovery phase may be better. Rather than deep tissue massage, classic Swedish massage strokes like effleurage and petrissage, myofascial techniques, and lymphatic work may be more suited to promoting healing while deeper tissue work can be considered with time.
What to Do After a Deep Tissue Massage
Stay Hydrated. Staying hydrated is an important aspect to general recovery from all types of massages. The body is always circulating fluids in and out of tissues and cells, and massage may increase this type of fluid exchange for a brief period of time. The body is not “flushing toxins” as many people are apt to associate with massage, however, massage can enhance normal healthy circulation.
Keep Moving. Gentle walking or stretching and activities that facilitate these types of movements like a gentle yoga class may be helpful after deep tissue massage. Activities such as these encourage healthy circulation without overstressing recently treated tissues. What one should avoid is re-engaging immediately in the activity which contributed to the need for deeper tissue work, whether this is prolonged sitting and laptop work or intense exercise.
Give Your Body Time to Recover. Generally, the body may experience some light soreness after deep tissue work for the next 24-48 hours. Typically, this can be managed with things like gentle self-massage strokes, and natural anti-inflammatories like topical CBD or topical arnica preparations. Pain should not be significant and should dissipate within a day or so. However, this is one reason why intense exercise or training should be avoided as it may have a negative affect on muscle tissues which were just released.
Pay Attention to How You Feel. As always, it is important to pay attention to how the body feels. Neglecting to do so is one thing that can get us to the point of needing more intense deep massage work in the first place! Finding ways to move your body without overusing muscle groups where you tend to experience pain and paying attention to your posture potentially even via an alarm set multiple times in the day can help reduce the need for further work.
Deep tissue massage isn't about using the deepest pressure possible—it's about using the right techniques at the right time for your body. Whether you're recovering from long hours at a desk, preparing for another day on the river or the trails, or simply looking to move with less pain and greater ease, an individualized approach is key. At Gorge Naturopathic and Massage, each session is tailored to your goals, your body's current needs, and the pace that allows tissues to release safely and effectively. If you're looking for deep tissue massage in Hood River, abdominal massage for digestive health, therapeutic massage for stress management and relaxation, or experienced sports massage in Hood River, do seek us out. Over time, thoughtful bodywork can become an important part of staying active, reducing chronic pain, and helping you continue doing the activities you love.
Written by Dr. Carrie Decker, ND