Deep Tissue Massage - Is it Beneficial?

As a massage therapist, I often get asked if I do “deep tissue massage.” Deep tissue work is pretty self-explanatory: the therapist uses very firm pressure, well into (and beyond) normal pain thresholds. In fact, people often expect that a massage should hurt. “No pain, no gain,” is one cliche saying. “It hurt so much for days! But then I felt great after…” I’ve often heard. You can find countless therapists, spas, and clinics that specialize in deep tissue work. But is it really that beneficial?

After working with patients on their chronic and acute issues; after giving thousands of massage treatments; and after 4 years of intense osteopathic studies in anatomy, physiology, and biomechanics, I don’t think so.

What’s happening to your body during a deep tissue massage? When I’m applying a certain level of pressure to the muscles, it creates an inhibitory response in the nervous system and relaxes the muscle. This usually feels great. It's one reason why we love physical touch so much. If, however, I increase the pressure beyond a certain point, your muscles will automatically tighten-up. This is a stress response! Your body senses that the level of pressure is reaching beyond its comfortable limit, and increases muscle tone to protect it from getting damaged. The same thing is happening in the classic knee-jerk reflex (also known as patellar reflex), where the doctor, or whoever, hits your knee just under the kneecap, and you kick your leg a little bit. It's automatic; your nerves sense that the tendon is getting stretched to a dangerous point, and then reflexively protects itself by tensing-up and firing the muscles. The same thing happens to your muscles during a deep tissue massage. They tense up to protect themselves, creating more muscle tone. We want to create less muscle tone, not more.

Deep tissue work can actually damage the tissue you’re trying to heal. Take, for example, that chronic shoulder pain that many have, right at that point between the neck and shoulder blade. It may feel painful, tense, ropey, or like there’s “knots,” or points of adhesions back there. This might have been going on for a long time too. And even though it's been treated and given temporary relief, it always seems to come back.

Deep tissue is often recommended for this kind of thing, meant to decrease pain and “break down” those adhesions. “Breaking down” in this way means you’re actually damaging the muscle fibers. And unless you know your anatomy really well, there are a lot of veins, arteries, nerves, and vessels under the skin that you are likely damaging at the same time. Which is not great.

Damaging the tissue kickstarts the body’s way of healing itself, which is through the inflammatory response. Inflammation and swelling follows tissue damage, and then, as the swelling starts to diminish, the body lays down a thicker matrix of fibrotic tissue to replace the damaged ones. Fibrotic tissue is less pliable, less elastic, and less mobile than the original tissue, and is known by another name: scar tissue.

So yes, deep tissue massage can actually keep you locked in a cycle of pain, inflammation, and decreased range of motion. However, after a few days post-deep tissue massage, people often do feel better. The body is amazing at healing itself. But unless the underlying causes are addressed, the issues will likely keep coming back. For treating the underlying causes of pain and dysfunction, I recommend Acupuncture and Osteopathy.

In my massage practice, I utilize light to medium pressure. The goal is relaxation, inhibition of your muscle tension, and calming the nervous system, using slow, steady, firm pressure. It's not meant to exhaust and deplete you, but to give you a restorative experience. Massage Therapy is a wonderful way to connect with your body, to relieve aches and pain, and de-stress from our highly stressful lives. And using the right amount of pressure can make you walk away feeling completely rejuvenated.