By Katharine Koeppen, RA

Why is deep tissue massage so popular? It's probably the most requested modality in my area of the country, and it's almost always requested by people who don't need or whose bodies cannot tolerate that style of massage therapy.

Deep tissue is a style of massage that creates a controlled reinjury of hypertonic, adhered muscle tissue and fascia through slow, deep pressure. It is normally performed on the deeper layers of muscle and is used for chronically tensed tissue. It is often painful when administered, painful for several days afterward, and may cause bruising when performed by an inexperienced, hurried or poorly trained practitioner.

Why do clients request deep tissue?

- They confuse "deep" with "effective." This is rarely true, but it's a common belief among unsophisticated massage consumers. As a practitioner, I can tell you there is nothing worse than having a client repeatedly ask you to "go harder" even as their muscle tissue is stiffening and mounding up under your hands in protest. Honestly, in 20 years of practice on all types of bodies, I have met exactly 3 people who truly required deep tissue work. All 3 were professional athletes with overdeveloped and constantly stressed musculature.

- The client believes they are getting more for their money if the therapist goes "deep and hard." The client will get the most for their money if they let a competent therapist design an integrative bodywork session based on the client's concerns and presentation on the day of the session. 

- They work out at a so-called elite fitness center where massage services are offered, focusing on deep tissue, so this modality is familiar to the client. These establishments have a "no pain, no gain" approach, and deep tissue massage dovetails well into that environment and that belief system.

 - They enjoy pain. Some people do, and massage is a "safe" way for them to exercise that need. I know a man who proudly refers to his massage therapist as "The Grinder," and brags to his coworkers about feeling pain for days after an appointment. People who just want a flogging get referred out of my practice very quickly.

- I've found the biggest reason people insist on deep tissue massage has to do with a lack of body awareness. They are so anxious and frightened of their own feelings that they will not permit themselves to feel anything at all. Therefore, they are only aware of aggressively deep pressure. I remember the first time I encountered one of these clients, an exhausted midlevel manager at a high stress PR firm. She repeatedly asked me to use deeper pressure, stating, "I can't feel anything you're doing at all." Eventually I stopped the session because I was just shy of bruising her, explaining that any further pressure would cause injury and gently asking, "Is there something about your job that's causing you not to feel?" She thought about it for a moment and the lightbulb came on. "Oh. Wow. I never thought of it that way." With trust established, she became one of my best clients.

My final opinion on deep tissue massage? It sounds impressive but is usually unnecessary and frequently inappropriate. A skilled bodywork practitioner can employ a series of light-to-medium pressure techniques that will allow you to release tension and discomfort in both body and mind. You'll go home feeling like you've received a deep tissue massage, but without the pain.