A massage therapist applying deep massage pressure which is not always better for the client

I never thought this day would arrive.

But the day has come that, as in popular music, as in fast food—we have arrived at the point where we understand that the most popular massage is not the best massage.

It can even be like fast food, a steady diet of which is not nourishing and eventually even harmful. I’m talking here about what passes too often for deep tissue massage.

To be clear, deep tissue massage at its best is a wonderful therapy. Many massage educators create whole books, tapes and other continuing education offerings with integrity, expertise and compassion—and well-researched and well-presented, true deep tissue massage is an essential learning and practice for all therapists.

However, a great deal, possibly the majority, of deep tissue massage work is not being done or promoted in a way that has intellectual or therapeutic integrity.

First, when you present in the menu of massage businesses, Swedish as a superficial therapy and deep tissue as the primary alternative, you set the stage for a misconception: that Swedish is superficial and deep tissue is, of course, deeper.

When presented with the implied question of do you want a superficial massage or a deeper one? How many people would choose superficial?

Falsehood

It is assumed if you want effective relief from muscle tension, deeper must be better.

What this ignores is that Swedish is not lighter or more superficial massage, although it may be taught as such at many schools.

U.S. massage has been strongly influenced by the often lighter, more flowing style of Esalen massage; and so what we call Swedish is often a blend of real Swedish—which was traditionally quite deep work involving serious petrissage and frictions—and the more effleurage-y style of Esalen massage.

The false assumption underlying bad and common deep tissue work is that to get a great therapeutic effect, therapists need to apply a lot of massage pressure.

This is false—in fact, it is as naïve as assuming that for music to be effective, it needs to be loud—because the relaxation of muscles is largely not a result of massage pressure; it is the result of the nervous system turning off the message for the muscle to be tight.

[Watch a video of the author discussing Deep Massage: The Lauterstein Method.]

Furtherance

There are three groups who have been building and furthering this myth and this unhealthy practice.

1. The general public, our clients. So many athletes and other heavily muscled people believe in no pain, no gain.

While adequate pressure is definitely needed for the client to feel well contacted, we now frequently encounter clients who show up requesting as much pressure as we can give, sometimes even boasting, “You can’t hurt me!”—as if that were a good thing.

These people, either by word of mouth or through past massage experience, have perhaps experienced ineffectual Swedish work that has been too light or not anatomically precise.

The fact is, however, what is needed—whether we are working lightly or deeply—is more intelligence, more sensitivity, more anatomical clarity, and therefore generally less force.

Substituting force for intelligence—whether it be in warfare or health care—is generally a bad idea.

2. Massage therapists. Many therapists have not had sophisticated massage educations. They have first learned assumedly lighter work and then, seeing that it may not be very effective, they simply add pounds per square inch.

Also, they are responding to the demand for excessively deep work as a matter of economic necessity; i.e., supply meeting demand.

Ironically, we see that a few years down the line, after working in private practice or as employees for a while, massage therapists suddenly becoming fascinated with craniosacral work, party because it makes obvious that you do not really have to use a lot of pressure in order to have a deep effect.

3. Massage employers. There is a natural tendency to create a menu of services. This doesn’t do justice to the fact that the best therapy is individualized for the client and that the best sessions often may include a variety of modalities, pressures and emphases.

The rigidity of therapeutic menus does an injustice to the individuality of clients.

Fallout

What are the negatives of all this?

  • Therapists are injuring themselves, trying to fulfill inappropriate requests for as much pressure as possible.
  • The resultant emphasis on naïve deep tissue is compromising the longevity of the therapists. They can’t maintain that level of pressure for 20 to 40 sessions per week without burning out physically, mentally or emotionally.
  • Some clients are ending up bruised or even injured through the application of excessive force.
  • The demand for deep tissue massage is, in turn, overly skewing schools’ curricula toward excessive pressure, orthopedic overemphasis, and neglect of the art and individuality that plays a key role in the best massages.

I would like to see a systematic attempt to educate the general public, therapists, students and employers out of the false belief that good massage has to be deep massage.

Fact

The most important piece of information that we need to understand and promote is that the change in tension levels in the body is something caused by changes in the nervous system, not by changes in soft tissues, as noted in the article, “Fascial Plasticity—A New Neurobiological Explanation, by Robert Schleip. (Journal of Bodywork and Movement Therapists, April 2003.)

The belief, however, is that muscles relax more with more pressure.

The truth is, muscles relax more when the nervous system tells them to.

Now, that does involve respectfully responding to the conscious expectations of the client regarding pressure—but it equally involves the knowledge and skill level of the therapist to educate the person both verbally and nonverbally through touch, that their releasing tension from inside out is more effective and longer-lasting than the therapist working from outside in with excessive pressure, trying to overcome tension with pressure.

Fixes

For clients: Relax! Please understand that your letting go from inside out is the best thing you can do for yourself—in general and while receiving massage.

With your letting go from inside-out and the therapist giving intelligent input with just the right amount of pressure, movement and intent, the therapeutic result will be deeper and more long-lasting.

For massage therapists: Refine your anatomical and physiological knowledge. Take advanced continuing education or generate a study group to deepen your enthusiasm for and knowledge of anatomy.

The more clear your touch, the less you will find yourself substituting force for intelligence.

Study more modalities that do not substitute force for intelligence: high-quality deep tissue training and other approaches such as Zero Balancing, Deep Massage (Lauterstein Method), shiatsu, polarity, Trager Approach and Hakomi Bodywork—all of which, while contacting structure very clearly, also recognize the importance and skill of contacting the nervous system (energy) as well.

For employers: Begin moving away from fixed menus and encourage your massage therapists to creatively meet the unique needs of the individual client.

If possible, give them enough time to take a meaningful history and discuss the clients’ needs, so they can appropriately individualize their sessions.

Future

Moving beyond the belief that deep means effective while less-deep means superficial will help create a future in which the best possible results of massage therapy are

realized—and that can only be good for massage clients, employers and therapists alike.

About the Author

David Lauterstein is the author of The Deep Massage Book: How to Combine Structure and Energy in Bodywork (Redwing Book Company, 2012) and Putting the Soul Back in the Body (self-published, 1985). He is the co-founder of Lauterstein-Conway Massage School in Austin, Texas.

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