What Is “Deep Tissue,” Anyway?
I recently received 10 minutes of the worst massage ever. This was at a local spa, which has been gradually raising its prices while not providing augmented amenities.
Case in point: This place, which shall remain nameless, now charges a base fee for a “relaxation massage.” If the client wants a “deep tissue” massage, an additional $10 is due at time of check-in.
The problem with this is that the receptionist who scheduled my session couldn’t tell me, when asked, exactly what the term “deep tissue” referred to. “Neuromuscular Therapy?” I asked, “Rolfing?” “Trigger-point therapy?” “Sports massage?” She didn’t know. In light of a lack of explanation, I decided to book my usual one-hour massage without adding on “deep tissue.”
Cut to the session room: I’m face down on the table, receiving something akin to butterfly wings flapping on either side of my neck.
Therapist: “I want to confirm that all you paid for was a relaxation massage. If you want deep tissue, we’ll have to take care of that [read: get more money from you] at the front desk.”
Me: “Can you work deeper? Say, on the far end of the relaxation-massage scale?”
Therapist: “We’re already there. This is all you paid for, a relaxation massage.”
Me: “I’m outta here.”
With that, I left the session room. First, being told that some sort of strange, light touch (not effleurage, not petrissage) session was all I would get for $80 was not exactly a form of “relaxation.” Second, I’ve received hundreds of massages. I know what average Swedish massage pressure feels like, and I know I don’t have particularly bulky or tight muscles that require strenuous exertion on the part of the therapist in order to effect relaxation. (Not to mention the fact that deep work can be performed without strenuous exertion; see Expert Advice in the July issue.)
I asked the front desk for my money back. The receptionist called the spa’s manager at home to tell him there was a dissatisfied customer requesting her money back. He said I should call back when he was at the spa. I haven’t yet; I wanted to first get some input from professionals in this field as to what the term “deep tissue” really means.
Can you tell me?
Until next time!
May 7th, 2008 08:47
Deep tissue is often a sore point with many therapists and spa owners.
People often come at massage from the perspective of “no pain no gain”.
As we are finding out these days- this may be a wrong headed notion.
Deep tissue refers to a series of techniques developed to work on restrictions, knots, adhesions, and the like. These techniques include such techniques as cross-fiber, compression, rolfing, muscle stripping, pin and stretch, etc. They can be quite painful.
Such techniques are often applied in specific “afflicted” areas only while the rest of the body languishes waitig to be worked on. Often some deep techniques can be combined with more whole body approaches like Swedish or Esalen.
There are very many effective techniques that are much lighter in touch that work very deeply into the muscle layers. That means you won’t necessarily feel any pain at all, but you will get results.
These include Ortho-bionomy(r), Trager, new style Myofascial release, Feldenkrais, Alexander, Bowen, and Rosen Work to name a few.
Some more modern deep tissue specialists work from a place of “allowing” tissue to find a way to move, rather than forcing tissues to
move. They can apply the standard deep tissue techniques but with a
different “listening” for body work. You won’t scream as much with this type of practitioner.
Finally, anyone that passes off butterfly flapping as any sane form of massage should be taken out into the street and rolfed by a herd of passing elephants.
and then removed from the roles of therapists.
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Adam Powney reply on May 9, 2008:
Brilliant, well said
May 7th, 2008 11:26
I can understand your dissatisfaction having recently received a super-light (and ineffective) massage myself. On the other side of the coin, however, in my practice I do have an extra charge for deep tissue massage. I specify the difference between “relaxation massage” - my signature treatment that is really a holistic massage using any or all of the techniques in which I am trained - and “structural deep-tissue work” - based on the structural integration/Rebalancing work in which I received a separate, full length training. I wanted to differentiate between the two types of session, and encourage people to make the decision up front regarding which type of session they were booking. In a deep-tissue session, I often will focus on a specific area (shoulder girdle, pelvis, neck & head), with only the amount of time necessary to integrate spent on other parts of the body. I’ve had occasions when clients were booking a relaxation (full body) massage, but then during the session were requesting me to work specifically with a physical issue/pain/injury using deep-tissue, and yet still expecting a full body treatment - all in a one hour session. Hence the extra fee. Structural work is a specialized treatment, and I took a full extra training to be qualified in it. I have no qualms about charging more for it. I don’t see relaxation massage as something of less value, and I certainly don’t skimp on pressure require to execute the strokes I’m using. I just like everyone to be clear before we start what kind of treatment is expected and being paid for.
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May 7th, 2008 12:17
I agree completely with Richard’s comments. I feel that you were ripped off by an unethical spa owner.
My clients come to me because I “listen” to their body to find the best way to get it to move. While every client doesn’t require deep tissue work, every client does require firm pressure delivered with specific intent. Anything less is creepy and inappropriate.
That said, in the past 3 years I did have one client who wanted absolutely no pressure at all and wanted lots of lotion. I felt like I was “buttering” her, rather than delivering a therapeutic massage. She said that’s what she gets at a local spa chain, and that’s what she wanted from me.
Maybe “butterfly flapping” is what some people want — but that should be sold as a different kind of massage, not anything that might be labeled as “therapeutic”.
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May 7th, 2008 15:31
I applaud the article and would like to read more exposure of the many phoney baloney spas springing up these days, using absolutely no intake skills to even determine is a person should or shouldn’t have deep tissue, then pawning off a shallow massage as a regular massage. I worked part time in a spa for a few years - they charged clients an extra 50 bucks for aromatherapy which was about an ounce of goop they paid 60 cents for. As far as deep tissue - yes, if someone in private practice has paid for and completed special training then it’s legit to charge a different price for it and discuss it with the clients first. But in spas, they are just promoting it to make money. I once had a hotel guest book me for a massage and when I got her on the table she told me she broke a rib hiking and falling that day. I spent 20 minutes talking to her about the situation, offered to leave without charge, or to do a simple acupressure treatment for the massage charge. She chose the latter. I was an independent contractor so I felt no pressure from the hotel to sell her something she shouldn’t have. Good massage therapists have several techniques in their repertoire and they apply them as needed. The lady in pre-menstrual misery and exhaustion from work gets a different massage from the 20 year old guy on vacation who pulled a muscle playing soccer two days ago. A mature therapist figures it all in and is so professional that every client feels like they got the best massage they’ve ever had. Spas can’t produce that just because they have a menu.
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May 7th, 2008 21:33
Deep Tissue, WOW! Okay. That means to me painful but able to stand. Okay again. Now if you are with a client that expects that level you better give that level or you won’t see that client again.
I expect that level if I am paying for it. If I do not get that level give me back my hard earned dough! After 12 years working in this profession I want and expect what I pay for or trade for. If you do not want to give me what I give you, pay me! Editor… bitch till you get your money back!
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May 8th, 2008 05:27
The client didn’t mention where they reside. Here in Michigan massage is still not regulated. ANYone can do massage here and charge just as much as someone that’s been trained in an accredited school. I worked in a day spa where there was a young lady that called herself a massage therapist and never had a day of formal training. She learned from her mother, who also worked there. The mother was an esthetician who also never had any formal training, but also did massage at the spa. To them deep tissue was just trying to mash harder as they worked. As long as the public is not informed, and laws not passed for minimum standards,experiences like this client’s are inevitable.
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May 8th, 2008 13:17
I wish I could tell you I was surprised to hear about your recent disappointing experience at a local spa. Unfortunately, stories like that have become all too common on the American spa scene. I, too, have been through the exact same scenario you described and had to make the difficult decision to terminate the treatment. What many therapists don’t seem to understand is that Swedish Massage (sometimes generically called Relaxation Massage by some spas) is actually intended to be a vigorous, circulatory moderate to firm pressure massage experience. Sadly, it is often practiced as the alternative to Deep Tissue and therapists will only offer a very light touch, and a surprisingly sharp attitude if you question the pressure level. Now, with regard to Deep Tissue, a good, simple definition would be “a style of massage that uses strong pressure through slowly applied firm strokes, often including friction techniques across the muscle fibers to release chronic muscle tension.” It seems the more familiar people become with massage, the more likely they are to request deeper work. It is our responsibility as industry professionals to be able to communicate effectively about the services that we provide and to consistently deliver a high quality bodywork experience for our ever-more-savvy customers.
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May 11th, 2008 09:53
I applaud the person who came forward with these comments. While I know that MANY places charge extra for “deep tissue”, I, in good conscience, cannot. Since I feel that you cannot do deep tissue work on all areas of the body (only those that require it), I cannot charge more. The only things I charge extra for in my sessions is the addition of hot stones or to do massage cupping. Everything else comes naturally to me. I do an eclectic massage that incorporates everything I have learned and which “tools” I use depends on the person’s tissues.
Yes, deep tissue is typically more pressure, but not always. It means, to me, that you are working the deeper structures of the body, including restrictions in fascia, tendenous areas and other areas that are “stuck”. Not everyone needs deep tissue work. Some just want a swedish massage with deeper pressure. Don’t confuse pressure with tissue! Deep pressure does not always address the restrictions which may require other techniques (such as cross fiber friction, trigger point work, etc.). I know that many who are certified in Neuromuscular massage take issue with what I am about to say, but having experience neuromuscular techniques and those taught by my school, who called it deep tissue work; I believe that they are the same thing. That would not be true of every school that teaches deep tissue work, however! I even compared our workbooks and techniques and they were the same. But that was only for MY school and those schools that teach the same techniques but call it neuromuscular work (and charge more to certify you in that technique).
When a client asks me for deep tissue, I ask him/her what that means to them. Sometimes it means deep pressure only. Sometimes it means they want specific work. It all comes down to talking with your client about their expectations. Spas do not do this well generally because that is not the way they seem to operate. Which is why I do not generally go to spas for my massages. Bottom line, talk to your therapist about what you want and if necessary, stay away from spas that charge extra for such things. There are many thouhts on this. I charge for my time and equipment. Some don’t . Neither is right or wrong. It is what we are comfortable with and feel is “fair”. I feel it is fair to charge for my time and equipment so if you get an hour of deep tissue, pregnancy massage or sports massage, it is the same price unless you add something that requires me to add additional equipement such as hot stones or cupping and then I am really charging for the extra prep and cleanup time and some to replace equipment that must be replaced occasionally.
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May 12th, 2008 08:15
I have been a Massage Therapist for five years now. I have worked in many different settings, Chiropractic office, day spa, medi-spa, beauty salon, and now I have found a great massage center that I work at full-time. I have built a loyal clientele over the past two years.
Many new therapists beleive that Swedish/ relaxtion massage is “easier because you give less pressure”. Over these five years, I have intuited, that is NOT TRUE at all!! Almost every client wants a firm to deep pressure even if they are receiving Swedish/relaxation massage. I give the same effort that I use when I’m giving a client a deep tissue massage. To me deep tissue means “getting in to get the knots out” or working on any other pain issue the client is having. I know I don’t do a perfect and technical deep tissue as noted in the other letters, (compression, cross-fiber friction etc…) but I am looking forward to learning extensive deep tissue work in all different modalities as my career progresses.
I hope this letter helps in understanding what spa therapists or newbies think just out of school. We need older mentors to help us! Also, if you get a bad massage in your own town, try offering to trade with them! Trsding with seasoned therapists (and newbies) is just one of the reasons I’m doing so well. Since, I have not been able to afford extensive continuing education the trading has been a great help.
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Richard Karasik reply on May 12, 2008:
Actually one of the most difficult massages to give well is the continuously flowing evenly paced style encompassed best perhpas by Esalen. No sharp changes in pace to remove the client from a state of reverie. No abrupt change in pressure, etc.
The Therapist has to maintain a soft focus 360 degree awareness of everything and make it all work without any “sharp edges”.
This is like watching Fred Astaire and Ginger Rogers (ok so I’m pushing geezerhood :-)) They make a flowing dance look effortless and they pull you along wih their energy - leading you to places you may not have thought even existed. That is a good massage of that style.
It is of course not a Thai massage, or a deep tissue massage- but they have other purposes and other energies.
The real problem lies in the ego-less education of the client. A well educated client is like a well educated oenophile. The more they know with the least amount of snobbery, or your ego in the way, the more informed they feel. The more informed they feel, the better they feel about sampling and understanding choices that up until now they didnt even know existed. This leads to them being more willing to interact with you more regularly- hence increasing your business.
Too many new therapists club the client over the head with too much therapist-babble and not enough client-speak.
R
May 16th, 2008 14:29
Hello Karen
Thank you for bringing this issue up. In my opinion there are numerous issues at play here. The first issue I see is the fact you have to, as a client/patient, choose what kind of massage therapy work you need prior to talking with your therapist. This to me is backwards. How can the average client/patient know what they need if a thorough intake and assessment has not been performed? Who is the expert here on massage therapy approaches? Of course the patients’ preferences and needs would be apart of this process.
Why are we as a profession still selling types of massage (sports, deep, pregnancy etc.)?
Why are we not selling expertise and services? As a well-educated therapist I use my professional expertise to assist the client in deciding what they need to achieve improved health.
This brings me to the next issue. Is the massage therapist a professional or a technician?
To be considered a professional one would have these characteristics:
1. The highest academic qualifications - i.e., university college/institute
2. Expert and specialized knowledge in field, which one is practicing professionally
3. Excellent manual/practical & literary skills in relation to profession
4. High quality works in (examples): creations, products, services, presentations, consultancy, primary/other research, administrative, marketing or other work endeavors
5. A high standard of professional ethics, behavior and work activities while carrying out one’s profession (as an employee, self-employed person, career, enterprise, business, company, or partnership/associate/colleague, etc.)
(http://en.wikipedia.org/wiki/Professional)
Does the massage therapy profession in the US meet these criteria’s?
And more importantly does the average therapist want to?
The kind of problem you have brought up will continue until the identity of the profession has been solved.
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Richard Karasik reply on May 16, 2008:
Ah Therein lies the rub! All the writings on this from the last 10 years will not be enough to sway people one way or another. More education tests, hoops to jump through, or more right brain approach.
On the one hand you have the professors. The book learners, the categorizers, the pigeon holers, the identifiers, and such.
On the other hand you have people who make assessments in ways that other people only dream of making assessments. These are people who have so integrated what they know into their sensorium, that they simply know.
Ala Milton Erickson, Moshe Feldenkrais, John Barnes and many others only have (had) to do a minor amount of intervention to GROK what is going on. For anyone that has ever taken a course in “reading clothes”, you will know that somethings that you have seen but have not understood start to become crystal clear when you are trained to see and listen. This is not the same as being trained to recite the names of the cervical nerves.
Being a professional guarantees nothing except that you have met professional standards as defined by a bunch of people who think they know what professional standards are. It says nothing of your ability to interact effectively with people, or assist in having results manifest.
Lest this devolve into a discussion on nature vs nurture, or natural genius vs learning lets agree to move that off to another forum.
The point here is that no one likes to feel stupid or intimidated. That’s why so may gaijin try uni as a sushi treat and never go back. They do not understand how to take the path to that delicacy. AND they do not want to feel stupid so they never ask for training in sushi 101.
For the most part as teachers, and educators trying to train a client’s palate for bodywork- we massage therapists suck.
Too many of us are ready willing and able to speak techno-babble at clients. But damned few are ready to engage and LISTEN.
All of your learning and your knowledge will not do half so well as simply listening a client effectively. Once you can do that, then your learning and knowledge can inform that listening. If you cannot listen a client effectively then all your learning and knowledge is interesting but useless window dressing which is, sad to say, often sufficient to pass proficiency tests.
Pass all the proficiency tests in he world and you still have BAD medicine, an epidemic of pill popping, and obesity, and endless malpractice suits. Go figure.
Listening is not the same as listening to.
Richard
May 19th, 2008 23:35
Hi Richard
What I call a assessment you call listening. We are speaking about similar things I imagine.
In my listening to the patient I take through history ( listen to the patients story) and then I confirm my hypothesis by using tissue provocation (special tests) that has been used by my peers (and confirmed sensitive to wht I am looking for).
This is what therapists need to do in my mind prior to telling the patient what type of work they need or don’t need.
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May 20th, 2008 16:34
What you just demonstrated at the spa was your lack of knowledge of just what deep tissue can be. Whereas I agree you didn’t get an answer from the receptionist, I don’t know of any education program for receptionists in the terms of massage.
Deep tissue means below the surface. It requires considerably more effort from the practitioner. Simply put, if you want more than an oil rub, you had better ask for deep or another specified modality.
Ten dollars is a small price to pay. A good deep tissue therapist is buzy - very. A bad one won’t have repeat clientel. The finesse required to execute deeper work is well worth the extra money.
The bottom line is, you are paying for the talents of the therapist. I only do deep tissue, structural massage. I don’t go hungry. When employed around several other therapists, my clients would walk past all of their discounted services and pay more for me. Whether it is 10$ more, or $10 less, really isn’t the issue.
The issue is - how much will you pay to get what you want?
Margo Siekerka
Missouri City, TX
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May 20th, 2008 16:59
Spas are not always the place to go for someone who is used to, and may require deep tissue work. That doesn’t mean that you can’t get deep tissue work in a spa, but generally people come there to be pampered.
I do charge an extra fee for deep tissue work.
Most of my “regulars”, athletes, and just plain tough guys expect and require what amounts to an Esalan type deep tissue treatment; “Full Body, flowing, continuous deep pressure with the probability of specific area neuromuscular treatments.”
Doing this type of work requires great stamina and a “cool down” period for the therapist. However, if we have a new client, we can only recommend the correct treatment after proper in take information and hands on assessment. We Do NOT charge an extra fee for one or two specific area treatments of “deep tissue”. Don’t worry, Karen. The cream always rises to the top. I promise that that spa will be scraping the bottom of the barrel for a long time to come.
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May 20th, 2008 19:05
I guess the challenge for all of us is to not be held captive by the words and instead find ways to deliver the intent. 90% of the peopel who want deep tissue are really saying things like “I need serious change in my life, my body, the way I see things. I need to feel that I have been touched at an important level. I want to feel like you have met me at a level that meets my needs for interaction. That is the meta conversation around Deep tissue unless the client knows the details of many kinds of body work and is just being helpful by pointing out which modality works for him or her.
The therapist has to be able to touch deeply and create deep effects without ruining their own body, sense of well being or ability to carry on for long periods of time.
There are ways to touch and create deep effects that do not involve having to have thumbs of steel, elbows of death, a sneer a leer and morbid laugh while blinking your one eye right in the middle of your forehead.
Water is soft- it carves up rocks for fun. No one would dare call the grand canyon “shallow”. The therapist must learn to conserve him or herself while helping to create great effects in the client. THere are many ways to do that.
Richard
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Dorraine Lowe LMT/AOBT reply on May 20, 2008:
Richards wording of water being soft and carving deep is beautiful. The description of your experience sounded like a new therapist or Esthetician performing a massage session. In some states this is legal and some are better than others. There are some fantastic techniques in Esthetics that can make a very relaxing massage if done by a well educated skin care professional but it is not a therapeutic massage and is not legal for people to cross over in all states.
All of the bad comments about spas bothers me because I have worked for good and bad ones. The bad ones were run by hairdressers or people out of the business entirely and have no knowledge of massage therapy or what it really is all about or how it is for a therapist to deliver the service.
Receptionists are often ignorant and may have never even had a massage before, so is best to call ahead and ask to get a return call from a therapist and ask them any questions you may have.
We are all in this business to perform a service to others. I truely do not think therapists at Spas are not as good or uneducated or not worth extra charges if the spa has that as their policy. Therapists get half of the charge or are paid by an hourly rate with other benefits or perks. I have found working for bad Spas that are not run by people in the industry will pay as little as 35% for services. This I think would make any therapist reluctant to work hard. This does not make it right but is a problem that creates bad vibes and poor attitudes of therapists that may be better in other settings.
I probably would have put out the extra $10 but then been very angry if it sucked. I would feel as any owner of a business, you have the right to get your money back if you were not happy with the service. Most places will give credit to use for products or to trade for another service depending on the policy of the spa. Either way you should have no problem getting something back. I think it would be helpful to speak to the manager and owner about your background and knowledge of the field. This is an opportunity to educate the ignorant and make changes. Please do not expect the same with all Spas.
May 20th, 2008 19:15
I have heard so many stories similar to this one. And, I was once a victum/employee of a spa.
I think that Spas should be regulated just like massage therapists are regulated.
Maybe regulated isn’t the right word, but they should have some kind of educational training.
It seems that there are quite a few spas operating off of the notion of unifying mind, body, and spirit, while mis-treating employees and ripping off “customers.”
It would benefit the health and wellness industry to see that oweners and managers of these establishments find the true meaning of integrating mind/body/spirit.
That’s all I have to say about that.
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May 21st, 2008 08:01
This is the problem with our current laws! There is NOT ENOUGH education! We should have a national standard like doctors and nurses do! (yes there are still poor MD’s, but at least they can answer basic questions, there are some states that you can call yourself another name and practice what took us years of schooling and supervised practice to earn)
It was unfathomable to me that in my native NY I can get a therapist who has a great understanding of their limits, my tissue and their career, but when I got to WI, I found myself taking on the managers position in a resort spa and RE-TRAINING all of the therapists, some of whom had not even graduated yet!!!! This is ridiculous. Our guests and clients deserve better, when will our profession wake up. If we want to be treated with credibility, START BEING CREDIBLE!!!!!!
I disagree, everyone involved in a SPA environment should be able to answer basic questions like that. They are the front face for the therapists. If they don’t know, it makes the therapists look like they won’t know.
And for heaven’s sake! I have NEVER met a therapist who was not able to accommodate my need for deeper or lighter pressure. Who do you guys go to? And doesn’t that prove that we are allowing SUB-STANDARD practitioners to work in an environment where we are trying (still) to prove ourselves to be worthy?
I also want to thank all of you who listen to your client’s bodies as well as their words. I find myself with guests who say that they want deep tissue, but when we get down to it, their body won’t open for deep techniques, so we do a deeper pressure swedish, and they don’t realize that there is a difference. I nearly always explain that they should never be afraid to ask for deeper pressure, and to know the differences between deep tissue and deep pressure.
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May 25th, 2008 10:26
The major difference between Swedish and Deep Tissue massage is specificity. Swedish focuses on circulation and larger areas. All of the Deep Tissue modalities that I have studied feel and attempt to correct specific muscles. The front of the thigh in swedish is the Rectus Femoris, Vastus Lateralis, Medialis and Intermedius is most deep modalities. Some trigger points can be very painful, but the deep work does not have to be painful- sometimes a good hurt is fine. Most modalities do not teach forcing the tissue to release- encouraging is more effective, but can still be painful if the tissue is quite immobile or active trigger points spring up. You should definately let the therapist know if the pain is uncomfortable. That is never the goal.
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May 29th, 2008 12:34
I’m finding this discussion very interesting. The way I see it is that there is a very large difference between spas and educated Massage Therapists. As an RMT, I use every technique that I have been educated in wether it is Deep Tissue, Myofascial, or Swedish. I don’t believe I should charge more for any certain technique because its not about the technique being used, its about the effectiveness for the clients situation. My belief is that because spas are so unregulated they can get away with charging more, confuse the public even more about what professional massage therapist really do, and really, its all about the mighty dollar isn’t it? I thought Massage Therapy was client centered care?
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May 29th, 2008 21:11
Point of clarification please - spas are unregulated in what regard? We have to get business licenses. If we employ estheticians we need to secure licensed staff. Same with massage therapists. Most of our insurance companies do not condone us making things up on the fly- in terms of product liability issues ( ohh try the sodium hydroxide deep clean rub …. - yeah right) etc. \
Spas are like any other business -there to create a “better than expected” experience for their clients. Not one massage therapist or spa in the world can claim to cure or fix anything - that seems to be the exclusive bailiwick of God perhaps so we offer experiences to enhance wellness however you perceive that.
We do not ” get away” with charging anything- however some of us do have marketing arms that tell us what the price points in any given market are. IE did you ever notice that you can buy anything on late night TV for any number of payments of either 19.95 or 29.95. Surely that crap can be costed out differently, but the price point is 29.95 that peoplw will accept.
In terms of effectiveness- how do you respond effectively to a person who wants to be cured… We cannot claim to cure anything - so as far as anyone is concerned massage is for fun! ( ok that was even too sarcastic for me)
Again i think you are painting spas with a darker brush than is needed. You might look instead at the fact that most one person massage shows are run by people who are trying to produce effects of wellness in their clients- as misguided as that may be or not. Ie they still haven’t gotten the basic fact that they facilitate their clients SELF return to wellness by being effective listeners- with all senses. Other than that they DO little else - even if there is a lot of rubbing and moving etc going on.
Most SPA directors etc are business people who have to focus on run rates, cost of materials per service etc even to stay in business. They are attempting to deliver a repeatable and predictable “SPA” experience that many will like. A single massage therapist has more leeway to tailor special approaches for special circumstancs sometimes with great results- sometimes not.
However i fear we are wandering off thread. I would be glad to participate in another if anyone likes.
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