Principles of deep tissue massage

The Principles
When doing deep tissue massage, there are several principles that should become integrated into your practice so that they become second nature.


 * Principle 1: Warm tissues up before deeper work
 * Principle 2: Work within your client’s pain tolerance
 * Principle 3: Flush tissues after deeper work
 * Principle 4: Slow, rhythmical, comfortable massage leads to relaxation and lengthening
 * Principle 5: Faster, arrythmical, painful massage stimulates and tonifies.

Principle 1: Warm up tissues before deeper work
A massage typically begins with fairly superficial, general strokes. The pressure should be firm but fairly light to start with. As the tissues become “warmed up” the therapist should start to apply more pressure, and work into specific areas of tension. Warming up the tissues prepares the client for deeper work, and it also brings circulation to any problem areas.

If a therapist does not adequately warm up the tissues before proceeding to deeper work, the client will be unable to tolerate as much pressure. In addition the work which they do will be less effective due to the restricted circulation that is commonly associated with musculo-skeletal complaints.

Principle 2: Work within your client’s pain tolerance
Many people seem to come to the massage table with the attitude that the more painful their massage is the more effective it will be. This belief is often based on their experiences with Physiotherapists or massage therapists with little training. The fact is that muscles respond to pain by tensing. If you are working hard enough to make your client tense up, then your energy will be wasted on fighting against them. Another reason that this doesn’t make sense is that we are typically trying with our massage to relax and lengthen shortened, contracted tissues. Clients with this belief need to be educated.

To ensure that you are working within your client’s pain tolerance it’s important to regularly seek feedback. Monitoring the following can provide you with the information needed to keep your pressure at an appropriate level.
 * Verbal & non-verbal feedback
 * Breathing pattern
 * Muscle tension

Please note that the use of verbal feedback in itself is not enough. Just because your client tells you that the pressure is OK, doesn’t mean that it is. If you’re using too much pressure, their body will tense. They will often hold their breath.

Pain scales are very useful when applying deep tissue massage techniques. Typically a pain scale of 1-5 or 1-10 is used. If you are going to use a pain scale, it’s important that you explain the reasons for using the pain scale, and what the levels of the pain scale mean. It’s especially important that you make it clear which point on the pain scale relates to the point where they no longer find the pressure comfortable, and are starting to tense.

For example

"I like to use a pain scale with my clients. It’s important that the pressure I use stays comfortable to you.  Some minor pain can be useful, but not if it’s making you tense up.  I want your muscles to relax and lengthen."

Principle 3: Flush tissues after deeper work
After some deeper work, a massage therapist should always spend some time applying some lighter, more general strokes through the area that has been worked. This acts to flush the area of any metabolic wastes that will have been released in the course of the deeper massage, and also to calm the nervous system.

The flushing effects of massage are explained further in the [Effects of deep tissue massage].

Calming the nervous system is important because pain has a stimulating effect on the nervous system, and overstimulation can lead to post-massage discomfort.

Principle 4: Slow, rhythmical, comfortable massage leads to relaxation and lengthening
You know from your experience of providing relaxation massage that slower, rhythmical massage tends to be more relaxing than faster arrythmical massage. These same principles apply to deeper work.

Slow deep longitudinal (in the direction of muscle fibres) stretching stimluates nervous-system receptors and leads to reflexive relaxation of the muscle.

Principle 5: Faster, arrythmical, painful massage stimulates and tonifies.
Rapid, arrythmical massage tends to stimulate the sympathetic nervous system leading to increased muscle tone. Painful massage tends to be stimulating, and tonifying.

Contributors
David McQuillan 2008