One of the areas I love to talk about is health communication.
Massage therapists can benefit from expanding their vocabulary of touch and improving their communication with prospects and clients.
“Deep Tissue” has no well-defined or agreed-upon meaning in the industry. Clients ask for deeper pressure when it is impossible or inappropriate to provide. What should a therapist do? And how can a therapist modify a treatment to meet the needs of more sensitive clients?
When I think of a client asking for deep tissue, I picture someone who likes intense massages or has a problem they want help with. My practice is to set a specific goal with the client.
What do they hope to achieve? How will they know if their time and money were well spent with me? This will identify the clients who want intensity from those who want a solution to pain.
Next, I manage the expectations of the client and together we co-create a plan of action. This is important for clients who believe massage therapists are magicians who can fix them or stretch one hour into six.
“I hear that you want is ___________. What we have time today is either ________ or __________. Which do you prefer me to address during today’s session?”
Assuming that the client is concerned about the intensity of the massage (they want to be run over by a steamroller, walked on by a horse) or their sensitivity (they cannot handle a lot, have inflammatory reactions, are scared it will hurt) here are ways that I can increase or decrease the intensity.
It’s critical to be adaptable. Some of these factors may not be under the therapist’s control. Others will be. Each of these can be mixed and matched. Every client’s body and nervous system are different. (Keep that in mind as this chart will not be accurate for every person.)
I teach many other factors of intensity in my classroom. Here are the main ones:
| Intensity | Depth | Speed | Tissue | Breadth | Position |
| Least Intense | Superficial | Static | Muscle | Broad (forearm) | Relaxed |
| Slow | Tendon | Narrow (fist) | Shortened | ||
| Most Intense | Deep | Fast | Ligament | Specific (Finger tip) | Neutral |
| Nerve | Lengthened | ||||
| Active |
The tissue depth that is being addressed is what most people think of when they think “deep tissue.” Tissue that is superficial is often less intense to have massaged than tissue that is deep.
Speed refers to two things:
How fast is your massage stroke? A massage stroke that is slower will be more relaxing and less intense than a fast massage stroke.
How quickly are you sinking in to the tissues? Are you allowing tissues to adapt and soften? Or are you digging into a taut area right away?
What type of tissue is being addressed? Muscle belly is often going to feel less intense than work on a tendon. A ligament is often going to be more intense still. Nerves can be most intense. (And should only be worked on by those who have been properly trained to do so.)
What are you using the manipulate the tissue? A forearm is a broad surface and can be used for light pressure as well as deep pressure. The area that it contacts is broad. The tip of a thumb or finger, however, is smaller. A smaller point of contact spreads the force over fewer nerves and therefore may feel more intense.
Finally, what position is the tissue in? Relaxed tissue will feel less intense than active tissue. Say the client has a temporal headache and needs work on the upper trapezius. A shortened upper trapezius (arm off the front of the table) will feel less intense than a lengthened upper trapezius (arm down by the side).
The hip will often be more intense when the client is sidelying as opposed to prone. How the nerves and tissues are exposed impacts the perception.
Briefly, some of the other factors I talk to students about:
- Setting
- Context
- Pillows and bolsters
- Environmental cues
- Treatment length
- Treatment frequency
- Warmup/pre-treatment
- Post-treatment