Deep Tissue Massage Techniques Part I

Methods of a Deep Tissue Massage

deep tissue massage
Deep Tissue Massage

The two main ways to apply deep tissue massage are through compressive techniques and stretching techniquesIn each of these sections, you will find information about when such techniques might be useful. 

You will also find safety guidelines with useful pointers to help you protect your own posture and joints while working, plus tips on how to be sure you are working both safely and effectively with your client

Use the tables provided at the end of each section to locate the step-by-step instructions for applying each technique to different parts of the body.

Compressive Techniques

Let’s begin your exploration of a deep tissue massage with a description of compressive techniques and the key holds, moves, and stances you need to know to apply the techniques. 

In this section, you will find examples of the techniques along with tips and tricks to help you compress tissues safely and effectivelyThe tables provided illustrate when each of the techniques might be usefully employed to treat different parts of the bodyAlso presented are safety guidelines specific to the application of each technique.

Introduction to Compressive Techniques

Each of the many different ways to compress tissues affects the body in the same wayWhen you lean onto a client using your forearms, fists, elbows, or a massage tool, and when you grip a muscle and squeeze it, you compress the tissue, temporarily impeding blood flow to that area. 

As you ease up, reducing the pressure, small blood vessels no longer constricted, and fresh blood floods the areaThe effect of compression is to create a pumping action that brings blood to an area that might have been slightly ischemic to start. Areas of tension subject to this form of compressive technique quickly flush pink or red

Perhaps by affecting the nerve sensors within the muscle fibers, compression of this kind also helps to decrease tension in muscles prior to the use of more profound techniques. Therapists and clients frequently report being able to feel muscles ‘letting go’ during the compression of a muscleThere is a palpable reduction in tension in the tissues

Tissues naturally compressed when we massage. Effleurage compresses tissues broadly and lightly, and petrissage compresses more firmlyMany of the ‘holding’ techniques that probably form part of your existing massage routine are localized forms of compression and maybe reasonably deep, especially if you are using your thumbs to apply them. 

In the sections that follow, we are going to explore techniques that require you to use body parts that you might not have used before in massage forearms, fists, and elbowsWe will also look at the value of squeezing techniques and the use of massage tools. Each of these methods of application may be modified to allow you to apply some intense pressure while safeguarding your hands, fingers, and thumbs in the process.

Forearms

You can use your forearms to compress tissues in two simple waysFirst, you can simply lean onto the client at the appropriate spot, using your forearm to apply a single, static pressure. 

This localizes the pressure to one area and is quite specific (but less specific than when using an elbow)An advantage of using your forearm in this way is that the technique can be easily modified to suit the needs of your clients. Pressing through a broad, flat area of your forearm will obviously deliver a broader, more diffuse region of pressure than when you lean against the client using a smaller region of your forearm. Notice too that it is not just the degree of contact you use that affects the client’s experience of pressure, but the region of your forearm you are using.

For example, the ulnar border delivers quite a sharp sensation relative to pressing through the more fleshy part of your forearm, where the bellies of the wrist and finger flexors lie. Using your forearm to apply static pressure is a useful way to apply deep tissue techniques to muscles all over the body, including the trapezius and gluteal muscles in side-lying.

Using Your Forearms for Static Compression

To use your forearms to apply static compression, follow these steps: 

1Identify the muscle to be compressed, focusing on the belly of the muscleWhen possible, position yourself so that you can aim the force of your pressure perpendicular to the muscle belly. 

2Rest your forearm against the muscle, and slowly lean into the tissues, keeping your wrist loose and your elbow at around 90 degreesGet feedback from your client as you do this and as you slowly increase pressure. Notice that you might need to change your stance considerably to be able to access the muscle in this waySquatting down, or changing the direction you’re working by just a few degrees, make a difference in the amount of leverage that you have. 

3Use your intuition and feedback from your client to decide when you have pressed deeply enough; remain there around 10 seconds before slowly easing up with the pressure. 

4Soothe the area either with oil or with effleurage-type strokes through clothing or a towel. 

5Repeat. Try the technique again, this time using your other forearmIt doesn’t matter whether you are right- or left-handed

You will soon discover that some positions are best done always using the left or right forearmFor example, Using Your Forearms on Adductors, and compare where your wrist falls with respect to the client’s proximal inner thigh when using your left or right forearm to treat the left adductor muscles. 

Another way to explore the use of this technique is to notice what happens to the sensation of pressure when you clench your fist, having already applied some pressure. Resting your left-hand palm up on a table or your thigh, lean onto it using your right forearm, keeping your right wrist looseWhile maintaining your pressure, clench your right fist. 

What happens to the sensation of pressure you feel in your left palm? For most people, when the pressure increasesStatic compression using the forearm tends to be most useful when it is used to address localized areas of tension for which deeper techniques (using elbows and massage tools) might be too severe. Static compression is also hugely beneficial for therapists who are hypermobile in their own wrist and elbow joints and who tend to overextend these joints when applying effleurage. 

The technique may be used with oil or be done dry through clothing or a towelNot having to use oil makes this a useful technique because it means you can use it at the start of a massage treatment session, helping to facilitate muscle relaxation through the towel before you begin. 

This technique can also be used when treating athletes to help overcome sudden muscle spasmBecause the application of localized compression reduces muscle tone in the muscle being compressedThe technique could even be incorporated into a chair massage routine for those of you providing on-site massage in offices, treating clients fully clothed. 

Clients with tight or bulky calf muscles often report slight discomfort when petrissage is used on this area of their bodies; they tend to be more sensitive to the contact points made by the fingers and thumbs, inherent to the application of this technique

Even when petrissage is performed smoothly and slowly, clients with tight calf muscles sometimes report sensations of pinchingFor this reason, forearm massage might be preferable to petrissage for warming the calf muscle at the start of treatment. A further advantage of forearm compression is that it links well to another compressive technique is the use of elbows, essential for those clients who require even deeper massage. 

A second way in which you can use your forearm to apply pressure is to use it with movementOne way to do this is to use your forearm to apply the effleurage strokes instead of using the palms of your hands. In response to requests for more pressure, many of the therapists press more firmly through their palms while effleurage

If you have tried this, have you noticed the strain the additional pressure puts on your wrist and elbow joints? Leaning into the effleurage stroke using your forearm takes your wrist and elbow joints out of the picture and provides firm, consistent pressure, which is especially useful for covering large, bulky muscles such as the adductors, hamstrings, and quadriceps, or for working into the iliotibial band on the lateral side of the thigh.

Using Your Forearms for effleurage

To use your forearms to apply effleurage, follow these steps: 1) Choose a large muscle group to start, such as the adductors, hamstrings, or iliotibial band, where you will have an opportunity to address a relatively broad surface area. 2) Starting at the distal end of the muscle, position yourself ready to lean onto the client, avoiding bony points (such as the epicondyles of the greater trochanter of the femur)

This might mean taking a much wider stance than you are used to when massaging, or even leaning on the treatment couch with the other hand to support your posture. 3) Using oil, lean onto the client and into the tissuesGlide slowly up the muscle, from the distal to proximal ends, finishing where you feel is appropriate for your client Fearful of causing pain, many therapists attempt forearm effleurage without actually leaning onto their clients

This makes the technique feel strenuous to apply, and of course, clients do not feel they are receiving a deep tissue massageOnce you are sure you are not on bony areas, intend to lean onto the client, lean onto them, and slowly perform your effleurage, supporting yourself to avoid damaging your posture

Provided you move slowly and get feedback from the client, this is a perfectly safe technique. 4) Repeat. As with static forearm compression, it is useful to change forearms and try the technique again, noting which forearm works best.

Safety Guidelines for Using Your Forearms

As with all techniques, a couple of safety points must be taken into accountIt is important that while using your forearm to effleurage you are also leaning onto the client. You are not simply using your forearm to sweep oil over the area but to apply a massage stroke designed to compress tissues

To do this requires leaning close to your client, so it is important to avoid unsupported flexion at your waist because this could strain your back. Make sure that when you apply the stroke you are either in a good, wide stance or that you are supporting yourself by resting your other arm on the treatment couch (or on the forearm you are using).

Now that you have taken your wrists and elbows out of the picture, the pressure is more concentrated on the glenohumeral joint of your shoulderAvoid grinding this joint. Grinding of the joint will occur if you remain in a static posture while performing the technique, pivoting from the shoulderAim to move along the treatment couch as you effleurage, moving your body in line with the stroke rather than remaining in one posture.

Advantages, Disadvantages, and Uses of Forearm Compression

After practicing compressive techniques using your forearm, tick the statements with which you agree in the following three lists

Advantages

1) Easily adapted to enable the therapist to apply more or less pressure 

2) Easily adapted to allow the therapist to localize pressure 

3) Avoids strain on the therapist’s wrist and elbow joints 

4) Is a useful alternative for warming the muscles of clients who feel petrissage tobe ‘pinching’ 

5) Easily links to compressive techniques using the elbows 

6) Can be used with oil or as a dry technique 

7)Can be used through a towel or through clothing

Disadvantages

1) It can take time for therapists new to forearm techniques to learn to lean onto their clients.

2) The application of the technique requires the therapist to get closer to the client and requires a change in the therapist’s working posturethis might take time to get used to.

When Is the Use of Forearms Indicated?

1) When you want to address localized areas of tension for which the use of elbow compression or massage tools would be too severe. 

2) When you have overused your own wrists and elbows but wish to provide massage 

3) When your wrists and elbows are at risk of damage through overuse or because you are hypermobile in these joints. 

4) When you need to address cramp in a muscle. 

5) When you wish to incorporate a compressive technique into a chair massage routine. 6) When you need to provide massage through clothing, such as at a sporting event.

Fists

Another way to compress tissues while avoiding strain to your hands is to use your fingers cupped into a fistThis technique works well when you need to apply compression with oil to a wide strip of muscle, such as when working up the medial calf.

Using fists to apply compression to the (a)medial calf (b)hamstrings

It is a really good technique easily applied with deep pressure to long muscles, such as the hamstrings, or with less pressure to long muscles, such as the tibialis anterior and extensors of the wrist and fingers. 

Many therapists use their fists to knuckle the trapezius muscle in a supine client, working the muscle either bilaterally or unilaterally on its upper fibres, up into the back of the neckThe disadvantage here is that it is tempting for the therapist to use a rotary-type movement at the wrist as he applies pressure

Although this feels delightful for the client, it is not particularly good for the therapist’s wrist joint. It is best to perform fisting with the arms held straight out in front of youThis means keeping your wrists in a neutral position (neither flexed nor extended) while keeping your elbows extended

This can be tricky, especially if you are hypermobile and it tends to overextend your elbows when trying to keep them straight. Working through a forearm, you can easily learn to relax and lean into the tissues, whereas this technique requires effort to maintain proper alignment in your own joints, and the risk is that you transmit this sensation of effort to your client

However, the use of fists does have a place in a deep tissue massage, fitting better to some parts of the body than to others. Fisting is also useful for strong therapists with large forearms, fearful of leaning too heavily onto their clientsTherapists unable to maintain strong wrist alignment can apply the technique single-handed, using their other hand to support the fist being used. 

Using Your Fists to apply Static Compression To use your fists to apply static compression, follow these steps: 

1Identify the muscle to be treated and position yourself at its distal end. 

2Cup your fists and, avoiding pressure to bony areas, lean gently onto the client, compressing the tissuesTry to keep your elbows and wrists in a neutral position. Purists insist that this technique must be performed with the therapist maintaining wrists and elbows in a neutral position

This does indeed protect these joints from compressive forces, but in reality, it is extremely difficult to maintainAs you glide over bony areas and follow the contours of your client’s muscles, you will naturally need to flex both your wrists and elbows. 

3Using oil, continue to lean onto the client as you slowly glide up the muscle towards its proximal insertions, getting feedback from your client. 

4Repeat. In an attempt to maintain wrists and elbows in a neutral position, some therapists hunch their shoulders, causing tension and pain in the upper trapezius and levator scapulae musclesGenerally, you need to set your treatment couch lower than usual to perform this compressive technique.

Variations in Fisting Technique

When fisting, subtle changes in how you apply the technique can have a large impact on how it feels to receiveFor example, you might choose to press through your metacarpals, keeping the proximal phalanges flat against the skin as you glide your fingers over the Or you might decide to add some ridge-like pressures. For this second method, simply angle the position of your hand so that you are running your proximal interphalangeal joints against the muscle rather than against the flat phalangeal bones

If you keep a tight fist this technique is safe for these joints. Safety Guidelines for Using Your Fists In addition to the following general guidelines for deep tissue massage, it is really helpful when using fisting to avoid pressing through the proximal interphalangeal joints while your fist is loose. Either keep your fingers fairly loose, cupping hands together, or use one hand to support the wrist of the other, pressing through the relatively flat surface provided by your phalanges. Alternatively, you can form a tight fist and press through your proximal interphalangeal joints

which should be firmly supported and unmovable in this positionadvantages, Disadvantages and Uses of Fisting After practising compressive techniques using your fist, tick the statements with which you agree in the following three lists:

Advantages

1) Useful for applying pressure with oil to a wide strip of muscle. 

2) An alternative technique for therapists with large forearms who are fearful of applying too much pressure to a client of disparate body size. 

3) May be easily modified to alter the client’s sensation of pressure. 

4) Not necessary to lean close to the client to perform the technique.

Disadvantages

1)It can be difficult to maintain wrists and elbows in neutral alignment. 

2) It can be tempting to use rotary-type movements when using the wrists on the upper trapezius in supine. 

3) Generally, the treatment couch needs to be much lower than usual to perform this technique. 

4) Therapists new to the technique tend to hunch their shoulders, causing strain in the upper trapezius and levator scapulae muscles.

When Is the Use of Fists Indicated?

1) When you wish to apply compressive techniques with oil to long muscles. 

2) When you have large forearms and wish to avoid deep pressure effleurage through your palms while treating a smaller client.

Elbows

Elbows are commonly used as part of a deep tissue massage routineThey can be used in two separate waysFirst, they can provide localized static pressure to relatively small muscles that require deep pressure (such as the tensor fasciae latae or levator scapulae) or to a small, specific area of a large muscle (such as the origins of the hamstrings).

(a) the tensor fascia latae, (b) the levator scapulae and (c) the hamstrings.

Second, they can apply what is sometimes called stripping—that is, the slow, continuous application of pressure with oil along with a narrow band of tissue. Covering a smaller surface area, the pressure facilitated by the use of elbows is deeper than when using forearms or fists and might even be as deep as when using a massage tool. 

For this reason, it is best to use elbows for deep pressure only after tissues are thoroughly warmed(Of course, all deep tissue techniques have a more profound effect and are safer to apply after tissues have been warmed using regular massage techniques.) 

Using Your elbows to apply Static Compression Use your hand to practice this technique on yourself before trying it on a client.

1Identify the spot you wish to treat and touch it with your elbow, keeping your elbow flexed. 

2Extend your elbow slightly, while still touching the spot, but do not add any pressure yet. 

3With your elbow on this same spot, still extended, lean onto the client. 

4Maintaining the pressure, slowly flex your elbow. 

5Ease up, reducing your pressure, and soothe the area. 

6Repeat. 

Notice that by changing the degree of flexion in which you hold your elbow by just a few degrees, you produce a disparate increase in the sensation of pressure reported by the client. Using Your elbows to apply Stripping to use your elbow to apply a stripping technique, follow these steps:

Stripping Technique

1Starting at the distal end of a thoroughly warmed muscle, identify the line of tissue along which you wish to strip (e.g., the centre of the calf muscle). 

2Place your elbow at the distal end of this line, supporting your elbow with the web of your other hand. 

3Lean onto your client with your elbow and, using the guiding hand, slowly move from the distal end of the muscle to the proximal end. 

4Soothe the area with strokes such as effleurage or petrissage. 5Repeat.

Safety Guidelines for the Use of elbows

Additional safety guidelines for using the elbows relate to the fact that the pressure applied is so localizedWhen using the elbows, you must never compress main vascular structures, lymph nodes or nerves. You need to take extra care in controlling this technique

Be especially careful when using oilyou must guide your elbow to prevent it from slipping, keeping the elbow in the correct position on the muscle. When using elbows to treat trigger spots, be sure to remove the pressure if the sensation of slight discomfort at the spot does not dissipate within 60 to 90 seconds

If the discomfort does not dissipate, this could indicate when you are pressing into a spot other than a trigger spot. Finally, remember that elbows should be used only after tissues have been thoroughly warmed

That said, with practice, many therapists become an expert at applying just the right amount of pressure with the elbows, by using this very pressure as part of the warm-up. Using elbows certainly facilitates the application of deep pressure, but such pressure doesn’t have to be deep.

Advantages, Disadvantages and Uses of elbows
Advantages

1) Facilitates the application of very deep pressure. 

2) Can be localized to a very specific spot. 

3) Avoids strain on the therapist’s wrist. 

4) Easily links to compressive techniques using forearms. 

5) Can be used with oil or as a dry technique. 

6) Can be used through a towel or through clothing.

Disadvantages

1) Cannot be used on all muscles. 

2) Can take time for therapists to learn to lean onto their clients when using elbows.

When Is the Use of Elbows Indicated?

1) When you need to apply very deep, localized pressure and do not have a massage tool available and do not wish to use your fingers and thumbs. 

2) For the treatment of trigger spots. 

3) When your wrists and elbows are at risk of damage through overuse or if you are hypermobile in these joints. 

4) When you wish to incorporate a compressive technique into a chair massage routine. 

5) When you need to provide massage through clothing, such as at a sporting event.

Squeezing

The simple act of squeezing tissues helps promote blood flow to the tissues in much the same way as when using forearms to apply static pressureCompression momentarily impedes blood flow to the area, after which pressure is released and blood returns. 

Petrissage requires single-handed gripping and squeezing movements that can lead to overuse syndromes in the flexor and extensor muscles of the forearm, as well as the overuse of the thumb

So it is useful for therapists to have an alternative to this technique. Squeezing enables you to use your shoulder adductor muscles as well as your hands to provide compressionSqueezing can be used statically but feels better to receive when combined with oil, and although it can be used on the quadriceps and hands, it is most commonly used on the calf.

Using Squeezing on the Calf

Squeezing may be performed with the client either prone or supine after the oil has been applied to the calf. 

1Sitting close to the client with his or her knee flexed, cup your hands around the distal end of the muscle. 

2Working from the part of the muscle closest to the tibiaThe deeper part of the muscle slowly grips the tissue. 

3Maintaining your grip, allow your hands to slide off the muscle, dragging it away from the tibia. 

4Choose another, more proximal spot on the muscle, and repeat. 

5In this manner, work your way from the distal to proximal ends of the muscleNotice how it feels to grip the main bulk of the muscle at its belly, compared with the thinner and less fleshy part near its junction with the Achilles. 

When treating the hands of clients, many therapists commonly use their own thumbs to apply circular pressures into the thenar and hypothenar eminences of the client’s palm. 

Although this feels pleasurable for the client, it does not provide particularly deep pressure (because most clients do not require deep tissue massage to their hands) and is potentially damaging to the therapist’s thumb. 

When treating clients who do require deeper massage, try compressing the fleshy thenar and hypothenar eminences in a similar manner to that described here for the calf.

Safety Guidelines for the Use of Squeezing Techniques

Squeezing is one of the safest compressive techniques, with relatively few risk factorsThe main consideration is that squeezing can be deceptively deep, so be sure to get feedback from clients when first practising this technique.

Squeezing On The Calf
Advantages, Disadvantages and Uses of Squeezing
Advantages

1) Facilitates the application of very deep pressure(to the calf muscles, especially) 

2) Provides an alternative to petrissage. 

3) Allows therapists to use their shoulder adductors in addition to wrist and finger flexors, thus reducing the likelihood of overuse syndromes. 

4) Is easily combined with oil.

Disadvantages

1) Cannot be used on all muscles. 

2) Can be difficult to use on large, hypertonic muscles, especially if the therapist has small hands.

When Is the Use of Squeezing Indicated?

1) When you need an alternative to petrissage for use on the calf 2) When you need to apply deep pressure to clients with large, powerful hands

Tools

Now let’s consider how massage tools are used to safely compress tissuesMany therapists are intrigued by the use of massage tools but often buy them and then don’t know how best they should be used. Fearful of not using them correctly, they might discard the tools and revert to using fingers and thumbs instead

Using fingers and thumbs as part of a gentle Swedish massage is tolerable and in fact essential when treating some parts of the body, such as the face. But they should never be used to apply deep tissue massage

Therapists who start working with clients requiring deep tissue massage sometimes fall into the habit of using their fingers and thumbs and thus suffer symptoms of overuse. Learning to use tools safely helps prevent you from sustaining overuse in your hands and allows you to apply deep tissue massage more effectively to some parts of the body

Though the tools cannot be used to treat all muscles, they are excellent for applying very deep static pressure to small, specific areas. They can be used without oil, through clothing, but work best when the area that has been treated can be soothed with strokes such as effleurage and petrissage.

Types of Massage Tools

Many types of massage tools are on the market todayYou can also use some everyday items as massage tools.

Everyday Items as Massage Tools

1 Tennis-type balls from a pet shop 

2 Index knobber 

3 Child’s wooden skittle from a thrift shop 

4 The knobble massage tool 

5 Plastic jack nobber 

6 Wooden “mouse” 

The least expensive tool you might use for compression is a simple tennis type ball available from a pet shopDesigned for dogs with strong jaws, these balls are much harder than regular tennis balls;

when used in treatment, they are placed beneath the client so that his or her body weight facilitates the compression. The balls work well with the client in the supine position when pressure needed on muscles such as the upper trapezius, rhomboids, or levator scapulae muscles. 

Although you will need to assist clients in positioning the ball against the part of their muscle that feels best, no effort is required from you to apply pressure to the area. Balls of smaller diameter can be used but tend to get lost in the padding of the treatment couch, resulting in minimal compression

To compress tissues such as the supraspinatus muscle or the upper fibers of the trapezius with the client prone, tools such as an index knobber are useful. When using a knobber, you will probably need to sit or kneel, or to adopt a posture with a very wide stance, to get good leverageYou should keep your wrist in a fairly neutral position.

Using Tennis Type Balls to apply Compression

To use a tennis type ball to apply compression, follow these steps:

Using Tennis Type Ball to apply Compression

1With the client in the supine position, place the ball so that it presses against that part of the muscle the client reports as feeling most beneficialAvoid pressure to the ribs, the vertebrae, and the medial border of the scapulaeRemove your hand. 

2Encourage the client to relax onto the ball for no more than 60 seconds. 

3Reposition the ball to a different area and repeat it

Avoid overworking the area, using the ball to apply compression for up to a minute maximumIdeally, it is best to soothe the area using effleurage following compression, but this means turning the client prone in this example. 

Sometimes it helps if clients help position themselves over the ball, moving slightly on the treatment couch until the correct spot reachedIn this method,

1simply hold the ball stationary as the client gets comfortable. 

2Place your massage tool on the spot (over the towel or facecloth). 

3Slowly start to apply pressure, perpendicular to the muscle when possible and getting constant feedback from your client. 

4Using your intuition, and with feedback from your client, maintain deep pressure for up to 30 seconds and then slowly release. 

5Soothe the area using effleurage or petrissage when possible. 

6Repeat if necessary.

Safety Guidelines for the Use of Massage Tools

Massage tools let you provide pressure as deep or deeper than when using your elbowsThe area being compressed is even more specific than when using your elbows. You need to ensure you are pressing into muscle and not into other vital structures

If you are in doubt, refer to the general safety guidelines for applying deep tissue massage. As a therapist, you will be accustomed to helping clients identify ‘grateful’ pain, that feeling of pleasurable discomfort associated with the release of tension in very tight musclesOf course, should your client report pain at any stage of the application, you should stop immediately.

Advantages, Disadvantages, and Uses of Massage Tools

After practicing compressive techniques using massage tools, tick the statements with which you agree in the following three lists:

Advantages

1) Facilitates the application of intense pressure

2) May localize pressure to a particular spot on the muscle being treated

3) Avoids strain on the therapist’s fingers and thumbs

4) Can be used with oil or as a dry technique

5) Can be used through a towel or clothing

Disadvantages

1) Not suitable for all muscles (such as muscles in the face) 

2) Can take time to gain confidence with applying the technique 

3) Requires a change in working posture to gain proper leverage

When Is the Use of Massage Tools Indicated?

1) When you need to apply very deep, localized pressure and do not wish to use your fingers and thumbs 

2) For the treatment of trigger spots 

3) When your fingers and thumbs are at risk of damage through overuse or because you are hypermobile in these joints If you have understood this type of massage therapy can help to resolve the most chronic pain issues then you can continue reading the next part of this series which covers a large area of massage therapy here.

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