The deep tissue issue

What does deep tissue mean?  Is it the same as deep pressure?  When do I apply this technique, or do I?  How is it performed without hurting my client? and, without hurting myself?  It is a common term used regularly by clients and therapists. Clients say “I want a deep tissue massage”; “you can’t hurt me”; and “no pain, no gain”.  Every massage therapist is faced with these comments and questions at some point and are best armed with educational tools and good communication to help clear up the deep tissue issue before, during, and after a massage therapy session.  

Certain types of deep pressure and deep tissue massage are more demanding on a therapist's body.  It is imperative the therapist gets fully trained with proper body mechanics and confidence working the deeper tissues.  I believe deep pressure and deep tissue are two different terms with varying degrees of cross-over.

While there are varying depths of pressure in a typical massage session, deeper, firmer pressure is related to the more fluid and whole body experience of Swedish Gymnastics.  During the intake session, a client is typically asked whether they want light, medium or firm pressure. Although this is subjective, a massage therapist will fine-tune the pressure to the client throughout the massage.

Deep tissue massage is aimed at the deeper tissue structures of the muscle and fascia that are causing chronic pain or are limiting range of motion.  The focus is specific to an area that requires a concentrated amount of work. Such as a client requesting specific sciatic work because they are experiencing pain in their upper leg and gluteal area.  Deep tissue work is easily incorporated into a general whole body massage session. A well trained massage therapist will have many techniques in their tool bag to deal with these deeper structural problems.

Deep tissue work does not always hurt, a common misconception.  If a client on the table starts to squirm, the therapist has missed an opportunity to adjust the treatment or communicate with the client about the sensation of pain before the emotional brain kicks in.  Tom Myers explains in the March 2018, Issue 262 issue of Massage Magazine, pain like this: “in my experience, we have to talk about imposed pain versus exposed pain.  If I am leaning into the body and working away, I may be imposing pain on the body, and that in my book, is a bad deal.  If there is pain stored in the tissues, I am willing for the work to be sensationful as a way to expose and expel the stored congestion.”  Sensationful is a term Myers coined to be mindful of the pain a client is experiencing during a session.

Pain is real and sometimes happens in a massage session.  There are a plethora of massage techniques that work more efficiently at releasing congestion than just pressing harder into the tissue.  The no pain, no gain attitude is not why most therapists got into this business.  However, all massage therapists should develop an understanding of and study the deeper structures to be able to offer a truly effective deep tissue massage while keeping the client safe.

Deep Tissue? Or is it Swedish Massage?

Have you ever wondered about the difference between Swedish and Deep tissue massage?  You are not the only one.  Deep tissue has become a prominent term used for massage therapy yet is often used incorrectly.  The term has a distinct technique which many properly trained therapists apply in their treatment rooms.  However, many people use it to describe deeper pressure which is actually accomplished by a Swedish technique.  Swedish Medical Gymnastics and Movement was developed by Henrik Ling (1776-1839). A Swede from Stockholm who is considered the father of Swedish massage.  He created this system of physical rehabilitation by combining his knowledge of gymnastics, and physiology from Chinese, Egyptian, Greek, and Roman techniques.  

Ling’s techniques were introduced to the U.S. in 1858 as “The Swedish Movement Cure”. Today, it is simply called Swedish Massage.  Today, all well trained massage therapists in the United States learn basic Swedish massage strokes to apply in their treatment rooms.  Some people call them “hello and goodbye” strokes, or “warm up and flush out” strokes.  Whatever they are called, these techniques facilitate an essential connection to the clients body by the therapist.  We all love a good knot pressed on and worked out, but just how the body’s internal system reacts to it is the key to creating and sustaining an effective release. A person who has regular massage will react quite differently from someone who has had very few, or very intermittent, hours on a massage table.  There are a lot of variables to consider before jamming your finger under someone’s shoulder blade.  Swedish techniques are invaluable when gauging tissue mobility and tenderness.  

What are the Swedish techniques?  Well, there are basically 5 techniques that are all integral of a Swedish massage.  To begin with, the “hello” stroke is called Effleurage.  It is a smooth stroking movement, usually in the direction toward the heart.  It can be long or short and is generally used to apply varying types of lubrication such as oil or lotion to help the therapist avoid pulling on the clients skin and hair strands.  Effleurage is usually applied with hands and forearms.  As the therapist strokes up and down the body with the intent of soothing the circulatory and parasympathetic systems they are also gauging the integrity of the tissue beneath their hands.

A therapist call tell a lot about the body on the table with just this stroke.  Is the tissue pliable or rock hard?  Does it move or is it stuck to underlying structures?  The depth the therapist can go depends on the response of the tissue.  The hands are having a conversation with the tissue at this point and will tell the therapist when it’s safe to go deeper.  It is at this point where the confusion about depth of this swedish technique as opposed to “deep tissue” comes in.  The conversation about Deep Tissue is lengthy and will have its own blog, so stay tuned.

The next stroke or movement is called Petrissage which comes from the French word, pétrir, meaning 'to knead'. Petrissage generally has a deeper effect on soft tissue than effleurage, and includes kneading, squeezing, lifting, shaking, wringing and rolling. Petrissage prompts the movement of  cellular debri by creating space between the myofascial layers and ground substance and can create movement between the many layers of skin and the underlying structures.  It can help remodel scar tissue and soften adhesions.  Petrissage has been used to help circulate adipose tissue and facilitate increased circulation; stimulate synovial fluid in joints; and generally move fluids and structures around to promote a healing.

Three more classic Swedish techniques called Tapotement, Friction and Vibration are next. Each is typically applied after the previous two.  These techniques affect the tone and circulation of the soft tissue.  Tapotement is a rhythmic tapping, drumming or cupping of the tissue.  Hacking is a type of tapotement where the side the the hand is used in a rhythmic hacking motion and is frequently applied to athletes limbs before sporting events to increase circulation to the area. Tapotement administered for a short duration is rather stimulating while a longer session can actually produce fatigue in a muscle or group of muscles. Many therapists use tapotement at the end of a massage to wake the client up and give them an invigorated feeling for the rest of their day.  Other therapists use tapotement for longer periods on certain clients where it softens up the tissue enough to make it more malleable and workable and creates a sedating effect. There are cautions with Tapotement. You don’t want to accidently hit bones, or pound over the kidneys.  It’s always best to get informed consent before beating away at a clients limbs.  Therein lies the fear of actually “hitting” a client which could be taken wrong.  

Friction massage is typically done using the ball of the thumb or a pointed object. It is a deep pressure massage done in small circular, or cross-fiber movements to penetrate deep tissues. The technique involves pressing on the tissue and rubbing it back and forth over the underlying muscle. Vibrations are a massage technique in which tissues of the body are pressed and released in an "up and down" movement. This often takes the form of a fine trembling movement applied using the palm of the hand or the fingertips of either or both hands. Some of the benefits of vibrations include relaxation, improved nerve function and muscle relaxation. It can affect superficial body parts as well as deeper internal organs. Vibration as a massage technique, is an efficient way to stimulate deeper tissues and organs.

With these techniques, nerve endings are stimulated, which produce tiny muscular contractions, resulting in an overall increase in muscle tone. This is thought to happen because of the stroke pressure being registered by the muscle’s mechanoreceptors in the fascia and Golgi tendon organ. A reflex action follows, resulting in the contraction of both voluntary and involuntary muscles.  I hope this helps identify Swedish massage as an avenue for varying degrees of pressure which is typically what a client is asking for with the term “Deep Tissue”.

Advantages to AiCM's Tuition Credit program

Receiving a good postsecondary education that will prepare you to have a successful and fulfilling career is more important than ever.  There are not many well-paying and fulfilling career opportunities for those with just a high school diploma.  However, postsecondary education is also more expensive than it has ever been.  College students are borrowing more money to finance the cost of their education and total student loan debt exceeds 1.3 trillion dollars which makes it the second largest consumer debt category in the nation just behind mortgage debt but ahead of credit card debt and automobile loan debt.   More than two million student loan borrowers have more than one hundred thousand dollars ($100,000) of student loan debt.

Receiving a four-year college degree and experiencing college can be a life changing experience.  However, with many colleges charging $65,000 a year for tuition room and board is it worth it to take out the amount of debt needed to finance such an education?  Many students who finish college and take out large amounts of debt do not end up with a job that pays enough to pay off their loans.  These graduates have set themselves up with a large burden which may result in a lifetime of financial stress.

Other heavily indebted borrowers end up with jobs that they are not satisfied with.  AiCM recently admitted a recent college graduate who was not satisfied with the job she had and wanted a job that was less sedentary and more physical.  She is now studying to become a Licensed Massage Therapist.  She is convinced that this career will fulfill her in a way that a desk job could not.  There are many college graduates like her who may regret accumulating debt by attending a four-year college program and then being dissatisfied with their employment prospects after graduation.

At AiCM we have developed a unique model where students can train to be licensed massage therapist in either or both the states of Washington and Idaho by making a modest down payment and then conducting massages in the student clinic to pay the remainder of the tuition.  Most of the school’s students finance their education through this plan.  

After making an initial deposit a student will have a balance of approximately $7,000.  They then have the option of working in the student clinic where the massage fees and the tips minus a modest allowance for oils and sheets will be credited to the student’s account.  In addition to paying off a student’s tuition the program also allows the student to hone and perfect their craft by administering many massages prior to graduation.  This allows them to graduate as a more confident and more effective massage therapist.

In addition to this benefit through the tuition credit program many AiCM graduates have built up a clientele by practicing in the student clinic and have been able to start their own successful businesses by using the clients that they met in the student clinic.  

The massage therapy field was recently voted one of the ten (10) best professions for millennials by US News and World Report because of its income producing potential, the flexible hours that are available to Licensed Massage Therapists as well as the expected growth and the projected need for more therapists in the future.  For more information about the top 10 jobs for millennials click the following link:

With this being said the profession is not for everyone.  However, if you or someone you know is the type of person who is a good listener, enjoys working with their hands, enjoys helping people who have temporary or chronic pain feel better and enjoys learning about the muscular and skeletal system and how it works then massage therapy and the tuition credit program might be a good fit.