Are You in Too Deep?

By Matt Alderton, November 1, 2020

As we continue to navigate the pandemic, massage therapists have had time to think about their practices, their clients, and how they can best take care of them both while also taking care of themselves. Part of this inventory might include taking a closer look at the techniques you most readily turn to when helping people manage pain, stress, anxiety, chronic conditions—any number of things.

For those massage therapists who regularly work with clients who request or need deeper massage to get relief, you know how taxing deep tissue massage can be on your body. Now is a good time to assess how often you are doing deep tissue work, as well as ways you might more actively protect your hands, wrists and joints.

“As we age, muscles fatigue faster. This causes strain to be transmitted to the more delicate tissues of the ligaments, tendons and cartilage,” explains myofascial trigger point educator Cathy Cohen, LMT, who teaches hand and wrist home rehabilitation to massage therapists. “That’s one reason why massage therapists experience carpal tunnel syndrome, tendonitis and musculoskeletal injuries.”

The pain caused by those and other conditions can be felt in both the body and in the bank account: Some of the injuries that can afflict massage therapists are career-ending, which means LMTs who do deep work must be extra vigilant about self-care and recognizing when they need to adjust their repertoire.

“One of the top reasons why massage therapists leave the profession is because they injure themselves from going too deep,” says massage therapist Jessica Van Antwerp, LMT, of Boulder, Colorado, owner of Jessica Lyn Bodywork and Integral Travel, through which she leads wellness workshops and retreats. “Doing deep-tissue massage is like trying to push a boulder up a hill for however long your client is on the table. If you specialize in that type of massage, you’re exerting that kind of force on your body for hours every single day.”

Which begs the question: Why offer deep-tissue massage at all?

“I do it because it works,” says massage therapist Ruth Cummings, LMT, owner
of Athletic Touch Therapeutic Massage in Albuquerque, New Mexico, where she practices what she describes as a “very targeted” form of deep-tissue massage that utilizes focused pressure rather than deep effleurage. “In my opinion, it’s the most effective type of massage there is for relieving chronic pain.”

In fact, a 2014 study in The Scientific World Journal observed “significant pain reduction and function improvement” in individuals with chronic lower-back pain who received deep-tissue massage.¹ In 2019, researchers writing in the journal Musculoskeletal Science and Practice likewise reported “clinically meaningful improvement in pain intensity” from deep work.² Deep-tissue massage might even reduce blood pressure and heart rate.³

For massage therapists who have clients who value and benefit from deep-tissue work, exploring ways they can get some of the same results without undue stress on their bodies and joints is key to career longevity.

Some veteran massage therapists explain that if you make smart, strategic changes to the way you give deep-tissue massages—and to how you care for your body in between them—your clients and your business can continue to benefit from deep work for years and even decades to come.

Start with these four tips:

1. Lean into it.

The cardinal sin of deep-tissue massage is using the upper body to deliver the pressure, according to massage therapist Melissa Cope, LMBT, of Asheville, North Carolina.

“A lot of therapists push with their arms or with their thumbs, which creates unnecessary wear and tear on the body. I don’t push,” Cope says. “Instead, I get over the client—perpendicular to the tissue instead of at an angle—and let them hold me up. Then I let go. I stabilize my joints and I drop my weight. I let gravity do as much work as possible.”

It’s all about efficiency, echoes massage thera- pist and physical therapist Dr. Theresa Schmidt of Newbury, New Hampshire, president of Educise.com, a provider of live and online continuing education for rehabilitation professionals. When you have good body mechanics, she says, you can increase pressure on the client’s body while relieving pressure from your own.

The key is stacking your joints. “Stacking the joints means avoiding hyperextending and hyperflexing,” Schmidt explains. “You want to keep your joints relatively straight, in what we call neutral position, and use your body weight.”

Given the importance of body mechanics, a hydraulic massage table can be a godsend, according to Cope, who says massage therapists benefit when they can easily raise or lower their table based on a client’s body type. “I adjust the table six times during a deep-tissue massage,” she says. “My rule for table height if I do not have a hydraulic table is: When a client is face down, I want to be able to hinge at my hips and plant a forearm flat next to their spine so I can drop all of my upper-body weight into it. That height can change with every client, and it is difficult to manually adjust a table for each session.”

2. Vary tempo and technique.

Van Antwerp achieves deep-tissue results with light and medium touch by embracing a slower, more deliberate massage tempo.

“Give the body time to respond to your touch and pressure,” she advises. “Giving a good massage is like composing a piece of music: Pauses sometimes can be just as powerful as the notes being played. Pausing and holding your pressure from time to time instead of constantly staying in motion gives the brain time to respond to the muscle that’s in distress.”

In other words, you can alleviate pain by manipulating muscles not just physically, but also physiologically—i.e., stimulating the nervous system in order to regulate muscle contraction from within.

“Instead of going in from the outside and trying to force the muscle fibers apart to get a tense muscle to release, I’m trying to trick the body into letting go of the muscle on its own,” Van Antwerp continues. “Basically, a contracted muscle is a muscle that’s not really moving. To get movement into a place that’s not moving, I’m a particular fan of vibration. Instead of gliding across the surface of the skin, I plant the heel of my hand or my fingers in a spot, and then do some sort of subtle vibration to gently tease the muscle fibers apart rather than forcing them.”

Schmidt uses myofascial release to the same effect. “Using myofascial techniques that are very gentle can retrain the nervous system to relax tension in an area so you don’t have to work as hard to get as deep,” she says, likening the body’s tissues to an onion. “If you work gradually with increasing pressure, you can peel off tension layer by layer, melting superficial or surface layers in order to access deeper layers without using excessive force.”

Positional release can similarly “melt” superficial muscles. “There are positions that will automatically release muscle tension by passively shortening the muscles,” Schmidt says. “Placing the body in a certain posture relaxes the muscle so you don’t have to work so deep, which is easier for your hands and re-educates the nervous system to release tension and ease pain.”

3. Take a hands-off approach.

Perhaps the best way to avoid injuring the hands during deep-tissue massage is to circumvent them entirely, sug- gests New York-based massage therapist Dr. Shari Auth, LMT, co-founder at wellness startup WTHN. Because she was worried about hand health and career longevity, she created her own method of massage that utilizes the forearms instead of the hands.

“The forearms are a more durable massage tool than your fingers and thumbs. And because they offer a wider surface area of contact, you can work more of your client in less time,” explains Auth, who uses the upper-third of her forearms to work clients’ backs, hips, legs, arms and even feet. “I reserve my hands for working on their hands, head and face. That’s it.”

Schmidt and Cope also use forearms, along with knuckles and elbows. “You’ve got to get away from your hands and thumbs and use your whole body as a tool,” advises Cope, who says massage therapists can deliver more force with less effort by using a smaller surface area—the bony part of the forearm, for example, instead of the palm of the hand. “The muscles and joints in your hand are tiny; you need to come from bigger, stronger places when you’re doing deep-tissue massage.”

4. Practice hand self-care.

Irrespective of massage depth, basic hand hygiene can help massage therapists avoid injury and maintain dexterity. Especially important, therapists agree, are:

• Stretching: Cummings, who plays the drums, uses drumsticks to stretch her hands. Take a drumstick, she advises—a long spoon or strong ruler also work—and hold it in one hand; with the other hand, grasp the drumstick and rotate it gently in both directions to stretch the hand holding the stick, being careful not to overextend the wrist.
• Heat: Although ice relieves short-term pain, heat promotes circulation and healing, according to Cope, who recommends soaking both hands in hot water and Epsom salt at the end of a long day. Cummings, meanwhile, uses a paraffin bath machine to bathe her hands in hot wax.
• Rest: To protect your hands, schedule fewer clients and allow breaks in between them, Cummings says. Furthermore, consider how you pace your day, Cohen advises. For example, if you’re giving a deep-tissue massage to a muscular athlete whose bulk will fatigue you, allow a longer rest period for yourself after the treatment.

Deep work may be risky, but it also can be rewarding. To ensure that it helps your career instead of hurts it, remember this: To be a good massage therapist, you must listen to your clients’ bodies; to be a successful one, you must also listen to your own.

“If you overwork yourself,” Schmidt concludes, “you’re going to get bent out of shape—literally.”

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