Deep Tissue: How Much Pressure Is TOO Much Pressure?

I’m gonna say it a little louder for those in the back: DEEP TISSUE WORK DOES NOT HAVE TO HURT.

Countless times in my years as a massage therapist I’ve encountered clients who think that the bodywork isn’t doing them any good unless they are in pain on the table and sore afterwards. And I must admit, that early on in my career I would nearly kill myself trying to accommodate requests for super deep work. At the end of the day, I would have worked on multiple people who had this mindset, and my own body was breaking down because of it. I vividly remember driving home on winter nights with my hand out the car window, letting the freezing air bring some sense of feeling and relief back into my hands and arms. At the same time, my clients would say things like “I really hated you for a few days after my last session, but then I felt great!” This was not my idea of what healing should look like. If your massage caused you more pain than you were in when you walked in, that was a problem. Yes there is a therapeutic pain level, but you should not endure something beyond that. Clearly this intense deep work was not a sustainable way to practice massage for me or my clients.

I have since learned that there are better ways to address soft tissue dysfunction. Through many continuing education classes in modalities of lighter touch, energy work, and cupping, I was able to create a toolbox of methods for busting up stress, tension, and trauma without all the pain and pressure.

First I think it’s extremely important to realize that a lot of times when people seek deep tissue release, they are feeling pain deep within their bodies or feeling patterns of tension that involve many different areas and/or structures of the body. It’s not always evident that a lot of these issues are often caused by some underlying trauma (whether it be mental, emotional, or physical). For instance, feelings of low self-worth may manifest as chronic neck tension; Low back issues may be brought on by financial stress; A car accident (even a minor one) during adolescence may have put your body into a strained position, and compounded with the stress of the situation, your fascia always kept a memory of that holding pattern which now causes mobility issues later in life. I have seen all of these scenarios play out, and it’s incredible when you can finally release these traumas and allow the body (and mind) to heal. However, this is not accomplished by applying a vice grip of pressure to the body.

When too much pressure is used during therapy (especially on clients who’ve experienced mental and emotional trauma), you risk the body reacting in a way where it locks up, pushes back, and the bodywork will never reach past the superficial layers of tissue. The intent is to open these areas, not shut them up further. Very deep work often has the latter effect. Instead, I now employ softer myofascial work which unwinds the tissues, unlocking layer by layer. I also use a very intuitive and energetic approach, in which I literally listen to the body through my fingertips and move where I’m needed. In doing this, I may end up working on an entirely different area than where the pain is felt.

Your system of fascia is an interconnected sheath which encapsulates every part of your body. Each muscle fiber, visceral organ, everything in the body is covered in fascia. And when fascia tightens and adheres, this pulls throughout your body. (We will cover this vast and complex topic in a later blog.) So when you say “My left hip hurts” I may work on your right shoulder and move diagonally (with the winding nature of your fascia) to your left hip. In this way, we are treating the whole of the problem instead of just working one area which seems to be the problem.

(And sometimes it is just the left hip, maybe a deep trigger point is causing the pain. In which case I will take my time to work through the muscle layer by layer until it allows me to get to the trigger point.)

I may also use cupping to help achieve a release- by loosening the more superficial layers of tissue and promoting healing, circulation, and oxygenation to both fascia and muscle. Cupping can produce profound results, sometimes more quickly than manual therapy alone. However, the healing may take a few sessions, depending on how protective the body is of the sensitive area.

That brings me to the final point: slow work beats deep pressure… every time, all the time. If you come to me with one issue that is drastically reducing your daily function and quality of life, you’d better believe we’re spending most (if not all) of your session time working it out. I have many clients who have said “other therapists may spend 5-10 minutes on that area before moving on with their full body routine, but you stayed there (in the problem area) and it really helped.” This is key. Sure, I could give you a full body massage, but if your focus is your hamstrings but your arms are fine, then our session is going to be heavily centered around lumbar, glutes and leg work. Slowing down, using intuitive touch, and really focusing the work where it’s needed reduces the need for unbearable pressure, where the therapist is rushed to release that knot and move on to the next area.

Don’t get me wrong- I am still a big fan of trigger point work, I use my elbows a ton, and my pressure is by no means weak. There are always going to be trigger points that you just have to breathe through. But in the past few years I’ve transitioned into work that is more focused, less intrusive, and more effective. I believe that the body must welcome the work, and I must be invited into an area before any true release and healing can take place. I cannot force myself in, nor can I force the body to be ready to release what it’s held onto for so long. Never forget that the healing is yours, not mine. I am only there to facilitate and open space for your body to reach a more balanced and relaxed state.