Have you ever gotten a deep tissue massage where they really dig into your knots? The kind that "hurts so good?"
Or maybe it just kind of, you know, hurt, and you found yourself wondering if deep tissue massage will really help your back pain... or if you're just paying someone to beat you up.
You'll find this option on a lot of spa and massage clinic menus, and before we dive into the risks and benefits of deep tissue massage, we have to establish what this term even means (because the answer is surprisingly complicated).
What is Deep Tissue Massage?
“Deep tissue massage” is an unregulated term that basically means the massage therapist will use strong, hard pressure to massage your muscles. The intention is to massage the deepest muscles of the body, hence the name "deep tissue."
This type of massage is mostly offered by “medical massage therapists” (another unregulated term) who focus on pain relief and sports massage. It’s not designed to be relaxing, but remedial.
So when you compare deep tissue massage VS Swedish massage, they might both be using Swedish massage techniques (e.g. flowing, oily massage), but the "Swedish" option will only use light-moderate pressure, and the "Deep Tissue" option will cost extra and use heavy pressure.
However, it's important to note that there are techniques for massaging deep muscles that only use light pressure. This is a common misunderstanding even among massage therapists. "Deep pressure" does NOT equal "anatomically deep tissue." We'll talk a little bit more about this at the end of the article here. For now, I'll say "deep tissue massage" colloquially to refer to these heavy pressure massages.
The most important thing to know when you book a deep tissue massage is that pain is (usually) considered part of the experience, or even a goal. They’ll often say, on a scale of 1-10 where 10 is unbearable f*cking pain, you should be at a 7/10 pain throughout your massage.
Yes, deep tissue massage hurts.
But no pain no gain, as they say!
Why does Deep Tissue Massage feel good?
“Jesse, you're clearly ramping up to tell me how deep tissue is dangerous,” you think, “But deep tissue works for me - I feel great after!”
Yes… Why is that?
Much like a runner’s high, you might get a little buzz after your deep tissue massage and think “Wow, that was so worth it!”
Pain triggers your brain to release adrenaline (which dulls pain), and happy, relaxing chemicals like serotonin and dopamine to soothe you through the sensation. This is a helpful trick; if you break your ankle, you can power through the pain long enough to limp back to your tribe and get help.
However, we can also abuse this feature. Hurt yourself, get happy chemicals. It's a quick, easy way to feel better, and it can be habit-forming. This is the pattern of all self-harm behaviors: tissue damage becomes strongly associated with relief from physical or emotional pain, so we start to crave it.
You look forward to your monthly deep tissue massage, even though you grit your teeth and feel uncomfortable during the whole massage. "This will be worth it later," you tell yourself, and when you get off the table and feel relief, you think it worked.
But in the hours and days after your deep tissue massage, you may feel sore and bruised (or see bruises on your body). Within a week your body's back to normal, or maybe even feeling tighter than before your massage. The pressure has irritated your muscles and caused them to become inflamed, damaged, and traumatized.
The heavy pressure massage is not helping your muscles heal. You feel relief because the massage hurt, and pain triggers those happy chemicals. When we subject ourselves to aggressive treatments like this, it's not an exaggeration to call it self harm.
Can Deep Tissue Massage cause damage?
There are risks of physical damage, including:
Bone fractures. Yes, this has happened.
Swollen lymph nodes
Permanent nerve damage
Flu-like symptoms in the days after the session
Muscles tighten up later in a protective response (because they just got beat up!)
In addition, chasing this 7/10 pain sensation encourages the massage therapist to make less effective decisions in your treatment plan (more in this in the example story below). One, they're arbitrarily applying the same amount of pressure throughout the massage, and two, they're likely to target damaged, inflamed tissue (which is naturally sensitive to pressure and will cry out with big, strong, and deep pain sensations when messed with). We do NOT need to mess up tissue that's already in that state.
A Common Story: Deep Tissue Massage for Upper Back Pain
Here's an example of "chasing pain" that ultimately leads to an ineffective treatment.
In most cases of upper back pain (the type that comes along with slouchy posture and computer work), the muscles of the upper back are being lengthened to the point of tearing. If your massage therapist goes into the upper back with fists and elbows and irons out the muscles even more, it might be feel good for the reasons we saw above, but it will not solve your problem, and will in fact make everything worse in the long term. Releasing the back will deepen the slouch.
The upper back needs to be left alone to heal (or touched lightly to drain inflammation with lymphatic massage), and the antagonist muscles that are forcing it into this vulnerable position need to be released and stretched (usually the chest, neck, and sides of the torso).
But who wants their pecs massaged when their back is what hurts? So the massage therapist, eager to please their client, rolls up their sleeves and goes to town on the rhomboids, stretching and inflaming these vulnerable upper back muscles. It feels deep (it's easy to get that 7/10 pain we want when the muscles are already damaged and inflamed), and the client walks away satisfied, with the illusion of relief.
This is another danger of deep tissue massage: You think you're doing a good thing for yourself, so you spend your time and money on these treatments. This prevents you from moving onto a treatment that actually works.
Trauma, Pain, and the Mind/Body Connection
More insidious than this physical harm is the neurological harm from painful, deep pressure massage, which encourages you to disassociate from your own body over time. Let’s talk about “high pain tolerance.”
So many people have come in for a first appointment at my massage practice and told me "Do whatever you gotta do, I just want to feel better, and I have a high pain tolerance." This sentence always makes my heart sink.
A high pain tolerance is, ultimately, useful. Life is gonna knock you down, and if you can work through a headache, play soccer with a twisted ankle, or get through the dentist appointment without crying, that’s a win. If you live with chronic pain, no doubt you've learned to power through it.
But what IS pain tolerance? It's the ability to disassociate from your body and turn off those signals of “Ouch! Pain! Tissue damage! Something isn’t right! Alert! Alert!”
Which… isn’t always the right move. We need to feel pain in order to protect our body. If resting your hand on the hot stove didn’t cause pain, you would burn off your flesh.
Here's a brain teaser for you: pain does not exist in your body, in your muscles, or in your joints. Pain is an output of your brain. Always. It's something your brain does to protect you. Your brain senses that stove is hot (sensory input), assumes there's tissue damage happening, and sends out pain signals (nociceptive output) so you take your hand off the stove.
In many cases of chronic pain, the original injury has healed, but we are so divorced from ourselves that the brain continues to generate pain signals and limit range of motion in an attempt to protect you. It’s a downward spiral, and we can’t break it by injecting painful treatments into this spiral.
To fix pain we must always honor your nervous system. Massage is an amazing opportunity to heal pain, unique in its ability to address both the tissues of the body and the nervous system. It's a powerful way to rewire and calibrate the neuromuscular instruments we call muscles and demonstrate to the brain that there's no need to generate pain signals any longer.
If you go for a massage with the intention of blocking out your body's signals the whole time (as you grit your teeth through an intense deep tissue massage), you're missing out on a lot of benefit. In fact, you're teaching your muscles to flare up with inflammation and pain every time they're challenged, whether that's physically or emotionally (eg stress).
To summarize: high pain tolerance is a form of disassociation, and it's a very useful trick when we need it, but not something we want to practice more than we have to. Instead, let's foster mind-body connection.
What’s the solution?
There’s no need for massage to be hard or painful in order to be effective.
We can access and release deep muscles without using deep pressure; knowledge of anatomy will beat raw strength every time.
We can create long-lasting relief through neuromuscular change, where the brain and body reconnect and then they can't help but heal themselves. This will always be more effective than forcing a mechanical change that the broken mind/body will be quick to "correct" back to your standard (painful, tight) state.
"Gentle deep tissue" massage (now using the term anatomically, instead of colloquially) is of course, my specialty, and if you’re in Seattle you can book an appointment with me online.
At the end of the day, I’m not here to yuck your yum. It’s OK if you love intense, borderline painful deep tissue massage. Humans have all sorts of likes and hobbies that aren’t necessarily good for us: driving motorcycles, drinking wine, jumping off cliffs. If heavy pressure massage provides that cathartic release you need to get through the week, by all means, enjoy it. I just want you to understand the risk you’re taking when you sign up for this kind of service, and that there are alternatives.
For the rest of us... Next time a massage therapist promises to help you feel better by making you hurt, don't buy it.