The terms deep tissue and deep pressure are often used interchangeably, but actually they are completely different concepts in therapeutic massage.
Pressure is the force used by the massage therapist on the client’s body. Light pressure is usually calming and relaxing but doesn’t always affect the actual tissue being treated. Medium, firm pressure allows for overall relaxation but also provides enough force on the muscle tissue to encourage tissue release. It also conveys a feeling the therapist is completely present with the client. Deep pressure is the use of fairly heavy force in a massage or manual therapy treatment. It may be used to access the deeper tissues, but it is not the only way to achieve this goal. Deep pressure, especially if the client’s muscles are shortened and rigid, is often painful to the client, additionally it is taxing on the therapist’s body.
Deep tissue techniques, on the other hand, have the goal of releasing and realigning the muscles and connective tissues that are closer to the bones. The therapist may use deep pressure to access these tissues, but there are other effective techniques that don’t require deep pressure. Spontaneous Muscle Release Technique (SMRT) and Muscle Energy Techniques (MET) are two such techniques.
Spontaneous Muscle Release Technique (SMRT) is a positional release modality used by the therapist to naturally prompt the client’s body to regain homeostasis. SMRT uses gentle, passive contraction of muscles, tendons, ligaments and connective tissues to speak directly to the proprioceptors within these structures. (Proprioceptors are special cells that tell the brain where all the body parts are in space, as well as information about their status and how they are moving.) The passive contraction creates a mild slackening of the target tissue. The proprioceptors then communicate to the brain that “all is well,” and the brain and nervous system respond by releasing the targeted structures. The passive contraction is achieved via a direct line of very gentle compression through the bones and soft tissue. Any tissue may be targeted, no matter whether surface or deep, depending on the direction of the line of compression. No deep pressure is required or desired.
Muscle Energy Techniques (MET) is a modality where the client gently engages a muscle or group of muscles against a resistance provided by the therapist for a few seconds. This modality takes advantage of how the nervous system and muscles work together to prompt the nervous system to allow release and lengthening in a target muscle. It works on all skeletal muscles, both surface and deep. No deep pressure is required or desired.
In general, I would argue that while mild discomfort is normal, any significant pain produced because of a manual therapy technique conflicts with the goal of the treatment. Pain activates the sympathetic nervous system and produces a stress response in the body. In addition to the typical stress response of increased heart rate and blood pressure, the physiologic result in the musculoskeletal system is increased muscle tone and muscle guarding. None of these responses is consistent with the goals of manual therapy, even if the treatment is therapeutic and focused on a pathological issue. Although sometimes the sensation from a technique can be a “good hurt,” such a technique should be limited and temporary. I prefer to use more uncomfortable techniques only when other modalities have not achieved the desired results. Pain should definitely not be the basis of the entire treatment!
~Carol McGlauchlin, DOM