What Is Deep Tissue Massage? A Canadian Patient's Guide
What 'deep tissue' actually means
Deep tissue massage appears on nearly every list of popular massage styles, but the name can be misleading. It is not simply a very hard massage. Most practitioners describe a deep tissue massage as a slow massage with firm pressure and long strokes — similar to Swedish massage, but aimed at the deeper layers of muscle and fascia to ease built-up tension. [2]
The firmer touch is deliberate. In a deep tissue massage, the goal is to increase blood flow into the muscles and help release muscle tension that has built up in them. Deep tissue massage is one form of therapeutic massage, which focuses on the soft tissues of the body — muscles, fascia, tendons and ligaments — to reduce pain and improve movement. Massage therapy in general involves manipulating the body's soft tissues to manage a health condition or enhance wellness. [2] [1] [6]
Deep tissue vs. Swedish massage: what's different?
Swedish massage, also called classical massage, is the most common form of massage therapy in Western countries and the core of most massage training programs. In Ontario, it is the technique that registered massage therapists report using most often. Deep tissue massage builds on that same foundation: long strokes, but slower and firmer, with pressure aimed at specific problem areas. [1] [5] [2]
The two styles are not sharply separated in practice. A deep tissue massage usually starts with lighter, Swedish-style strokes to warm up the muscles before firmer pressure is added gradually. When researchers have directly compared massage techniques for low-back pain, the evidence has been insufficient to show that any one type works better than another. A relaxation-focused Swedish massage and a pressure-focused deep tissue massage sit at different points on the same continuum, so the choice depends on your comfort, treatment goals, and the experience you are looking for. [2] [1]
What happens during a deep tissue session
A therapeutic massage usually begins with an assessment rather than immediate pressure. The therapist checks your posture, flexibility and range of motion, and palpates the soft tissues to find areas of tension before planning the treatment. The plan may combine hands-on soft tissue work, stretching, remedial exercise and education about self-care. Throughout, the therapist should check in with you about pressure, and you can withdraw consent at any time — the treatment can then be modified or stopped. [3]
To reach the body's deeper layers of muscle and fascia and ease tension, a deep tissue massage can include cross-fiber friction, trigger point therapy, muscle energy technique, active release technique, and myofascial or positional release. During a deep tissue massage, pressure may be delivered with the thumbs, knuckles, forearms or elbows, and some therapists use stainless steel instruments to soften adhesions for particular problems. Across massage therapy generally, intensity varies from less than the weight of a hand to firm pressure on specific points. [2] [6]
The experience varies from person to person. Some people describe the deeper work as 'hurts so good' — physical discomfort that feels productive. But you are not meant to endure sharp pain: if any pressure is truly uncomfortable, tell the therapist right away. It is also normal for treated areas to feel sore the day after a deep tissue massage session. Speaking up lets the therapist adjust the pressure, whether you want lighter pressure for relaxation or firmer work on a specific area. [6] [2]
What deep tissue massage is used for — and what the evidence shows
Deep tissue massage is most commonly used for chronic back pain, neck pain and shoulder pain — common forms of chronic pain for which a person might book a session. A deep tissue massage can also help indirectly: someone whose headaches are linked to tension in the neck may get relief as those muscles loosen. Purported benefits include reduced pain and easier movement, but the evidence for those benefits is more mixed. [2] [1]
For low-back pain, a 2015 review of 25 studies with more than 3,000 participants found short-term improvements after massage, but the studies were low quality and reviewers said they had 'very little confidence' that massage is an effective treatment for low-back pain. A 2016 evaluation by a U.S. government agency found evidence that massage helped chronic low-back pain, though it rated that evidence as low strength. U.S. clinical practice guidelines from 2017 listed massage as an option for acute and subacute low-back pain, but not for chronic low-back pain. [1] [4]
Some evidence points to deep tissue massage specifically. A 2014 study in people with chronic pain in the lower back found that deep tissue massage reduced pain on its own, and pairing it with a nonsteroidal anti-inflammatory drug produced a similar degree of relief. [2]
For neck and shoulder pain, massage appears to help more than inactive treatments, but the benefit may not last. A 2013 review of 12 studies found massage more helpful than inactive therapies for neck and shoulder pain, yet no more effective than other active treatments. In one 2014 trial of 228 people with chronic neck pain, 60-minute sessions several times a week worked better than shorter or less frequent sessions. [1] [4]
Elsewhere, the research base is small. Five of six studies of massage for knee osteoarthritis found short-term pain relief, although two of the positive studies included aromatherapy oils. Headache studies have produced inconsistent results. For fibromyalgia, one review concluded that massage continued for at least five weeks improved pain, anxiety and depression in study participants, with no clear effect on sleep. [1] [4]
Risks, side effects, and who should check first
Deep tissue massage is not risk-free, but the overall risk of harm from massage therapy appears to be low. Rare reports of serious side effects — blood clots, nerve injury and bone fracture — have been documented, and some involved vigorous forms of massage such as deep tissue massages, or people at higher risk of injury, including older adults. More commonly, a deep tissue massage may leave bruising, soreness or aggravation of previous injuries. People with certain injuries or conditions should check with a healthcare provider first. [1] [2]
Some people should talk to a doctor before receiving deep tissue massage. That includes people with blood clotting disorders or an increased risk of bone fractures, people taking blood thinners, anyone with a blood clot in the leg, a tumor, osteoporosis, a spine disorder or an implanted medical device, and people with an acute injury or surgery within the last 48 hours. [2] [6]
Even where massage is used as supportive care — for example, for people with cancer — therapists may need to adapt, such as using less pressure in sensitive areas, and the evidence that massage relieves cancer-related pain and anxiety is not strong. Massage should also not be a reason to postpone seeing a healthcare provider about a medical problem; if you are unsure whether it is appropriate for you, discuss it with your provider, who may also help you choose a therapist. [1]
When you book, ask about the therapist's training and credentials, how many treatments might be needed, and what the sessions will cost, including what your insurance covers. Before treatment, you should be able to discuss which techniques will be used and what they should feel like. [1] [6]
Deep tissue vs. myofascial release and other pressure-based techniques
Myofascial release is not really an alternative to deep tissue massage — it is one of the techniques a therapist may use within a deep tissue session. Cross-fiber friction, trigger point therapy, muscle energy technique and positional release are others. Instead of choosing between named styles, you are more likely to receive a combination tailored to the areas being treated. [2]
Therapists may also blend in related approaches such as instrument-assisted soft tissue mobilization, cupping or passive-resistive stretching. With more than 80 types of massage in existence, sessions vary widely from one therapist to the next, so the best fit often comes down to the therapist's hands-on assessment and your feedback about pressure. [6] [2]
Talking to a massage therapist about deep tissue work in Canada
Regulation of massage therapy differs across Canada. Ontario provides one example: therapists there complete a two- to three-year diploma, pass the College of Massage Therapists of Ontario's certification examinations and register with the College before practicing. Only registered practitioners may use the titles 'registered massage therapist' or 'massage therapist,' or the letters RMT or MT. Therapists trained abroad, or in a Canadian province where massage therapy is not regulated, must have their credentials assessed before registering in Ontario. [5]
Most registered massage therapists in Ontario are self-employed and work in massage therapy clinics, multidisciplinary health clinics, hospitals, rehabilitation centres, fitness clubs, nursing homes, hospices or private practice. Their work involves assessing and treating physical dysfunction and pain of the soft tissues and joints, mostly through hands-on techniques; deep tissue and Swedish massage are among the most commonly used approaches. Treatment can be tailored to acute or chronic conditions, injury recovery, stress, post-surgical recovery, and flexibility or range-of-motion goals. [5] [3]
Cost is a practical question for many Canadians. In Ontario, for example, massage from a registered massage therapist is not covered by OHIP, though extended health insurance plans may pay part or all of the cost — coverage varies from plan to plan, so check yours. Beyond cost, a first appointment is a good time to ask what the therapist recommends for your situation and how the treatment will be adjusted to your comfort. [3] [1]
