Deep Tissue Massage is a much more focused type of Therapeutic Massage. Although some of the strokes are similar to Swedish Relaxation Massage, the movement is slower and the pressure is deeper and concentrated on areas of tension and pain in order to reach the sub-layer of muscles and the fascia (the connective tissue surrounding muscles) to release chronic muscle tension or “knots” also called adhesions. Deep Tissue Massage focuses on achieving therapeutic relief for these problem areas.
Is Deep Tissue Massage Painful? At certain points during the massage, most people find there is usually some discomfort. It’s important to communicate proper depth so your therapist does not go to too light or too deep, outside your comfort range. You should always feel free to speak up if the pressure is too much for you. If the pressure is more than you can comfortably take, you might unconsciously tense up, guarding your body against pain. This makes it harder for the therapist to achieve results.
Will I Get Results With Deep Tissue Massage?
It’s important to be realistic about what can be achieved with one Deep Tissue Massage. Many people want to get rid of all the tension they’ve built up in their body over many decades, in just one session. They ask for more pressure, thinking that if the therapist just pushes hard enough, they can get rid of all their knots in an hour. In fact, undoing chronic knots and tension built up over a lifetime is best achieved with an integrated program that includes exercise, correct posture, relaxation techniques, and a regular program of Deep Tissue Massage. After Deep Tissue Massage it’s important to drink lots of water to help flush lactic acid out of the tissues. It’s possible that you might feel some soreness the day after a deep tissue massage even if you do drink water. This means a lot of waste products were flushed out of the tissues. The soreness should pass within one or two days. Your Massage Therapist may recommend applying ice to specific areas. If you seek relief from chronic muscle pain and you are able to tolerate more direct pressure, greater long-term therapeutic
DEEP TISSUE MASSAGE an INTRODUCTION
A deep tissue massage is not just a firm massage where you apply more
ANATOMY & PHYSIOLOGY Muscle Structure.
Muscles are classified into three different types, which are skeletal, smooth and cardiac. For the purpose of this course, we are mainly going to concentrate on Skeletal muscle, as smooth muscle is mainly found within hollow organs and cardiac muscle is found within the heart. Skeletal muscles, also known as striated due to its appearance, or voluntary due to its action, are attached to bones and deal with movement. These muscles are made up of fine, thread-like
Each muscle fiber has an individual wrapping of a fine connective tissue called endomysium, which is then wrapped into bundles called fascicule and are covered by the perimysium. This is what forms the muscle belly, and has its own covering called the fascia epimysium. The fascia acts as a “Clingfilm” around muscles, giving them support and also acts as a pathway for nerves, blood and lymph vessels. When a muscle is damaged, fibers become torn and the connective tissue around the muscle is also damaged. Fluid seeps out of torn fibers, which can cause localized swelling. This fluid tends to stick the fibers together which causes pain as the muscle is irritated by the slightest contraction. The fibers stop sliding as effectively and the fascia gets tighter and begins to constrict the muscle. The fascia can also become torn and the loss of elasticity can create tissue congestion. If the body is held in the same position for too long, such as sitting at a computer, then the fascia can easily adapt to that shortened position, and any attempts to return it to its normal length can be painful. There is then a temptation to remain in that position, which in turn worsens. Muscle Shapes The bundles of fibers within muscles will determine the shape of the muscle. The commonest muscle fiber arrangements are: Parallel fibers – these muscles have fibers that run parallel to each other in length and can sometimes be called strap muscles. These muscles have great endurance but may not be that strong due to their length. An example would be the Sternocleidomastoid (SCM). Circular muscles – these muscles are usually circular in shape and an example would be the muscles surrounding the mouth and eye.
Convergent – this is where the muscle fibers converge to an attachment to a bone. The fibers are arranged to allow maximum force and can sometimes cross joints which have a large range of movement such as the Pectoralis Major. Pennate – these are made up of short fibers so the pull is short but also strong, though the muscle tires easily. Fusiform – these are sometimes included within the parallel muscle group and are made up of spindle-shaped fibers. A good example is the Biceps Brachii as the belly is wider than the origin and the insertion. Muscle Movement Muscles are only every able to contract or pull. This means they have to work in groups and even when carrying out an action, do not work alone. A joint, therefore has to have two or more muscles working together. As a muscle contracts, the second muscle relaxes, and as this second muscle contracts, the first muscle relaxes. This is called Antagonistic action as they are pulling in the opposite direction to each other but without working against each other. One end of the muscle needs to be fixed, which is known as the origin and as that muscle contracts, the other end of the muscle moves towards the origin. The name given to the end of the muscle that moves towards the origin is called the insertion.
Muscles of the Back – Name Position- Action Trapezius Upper- back going down to the spine Moves scapula up, down and back (retracts) Raises the clavicle Latissimus dorsi Across the back at the sides Used in rowing. Adducts, extends and medially rotates the shoulder joint Erector
Pectoralis – Front of chest, under breast Pulls arms forward and assists rotation of the arm Deltoids Surrounds shoulders Lifts arms sideways, forwards and backwards Muscles of the Arm and Hand Name Position Action Biceps Brachii Consists of a long and short head. Runs from under the deltoid to elbow Flexes elbow Supinates the forearm and hand Triceps Brachii 3 muscles that form the back of upper arm Extends the elbow Brachialis Upper arm, deeper than the biceps Flexes the elbow Brachioradialis On the thumb side of the forearm Flexes the elbow Flexor Carpi Radialis Middle of the forearm Flexes and bends the wrist drawing it towards the forearm Extensors Carpi Radialis Little finger side of the forearm Extends and straightens the wrist and hand Thenar muscle Palm of the hand below the thumb Flexes the thumb and moves it outwards and inwards Hypothenar muscle Palm of hand below little finger Flexes little finger and moves it outwards and inwards.
Muscles of the Legs -Name Position Action- Gluteals- 4 muscles, 3 of which make up the buttocks Used in walking and running adduction and rotation of the thigh, and extending the hip Tensor Fasciae Latae. This is the 4th Gluteal muscle. Runs from the iliac crest and in-between the two layers of the IT band Provides lateral stability to the knee. Facilitates walking Hamstrings 3 muscles that run the back of the thigh Flexes and extends the knee Gastrocnemius is Located with the soleus at the calf of the leg Flexes the knee Plantar-flexes the foot Soleus Calf of leg, below the gastrocnemius and attaches to the Achilles tendon Plantar-flexes the foot Quadriceps extensor Front of the thigh Group of four muscles Extends the knee, used in kicking Sartorius is The longest muscle in the body, crosses the front of the thigh Flexes the knee and hip Abducts and rotates the femur Adductors Group of muscles of the inner thigh Adducts the hip (brings in) Flexes and rotates the femur Abductors Buttocks region and thigh on the outside Abducts the hip (takes away) and rotate the hip Tibialis anterior Outside of the tibia at the front of the lower leg Inverts the foot Dorsiflexes the foot Rotates the foot outwards The main muscles are at the front of the thigh and are called the quadriceps. They are responsible for extending the knee joint and flexing the hip. The Adductors are the group of muscles on the inside of the thigh and moves the leg in towards the body. The Abductors are on the outside of the thigh, and moves the hip outwards. (Remember that the term abduct means to take away). The hamstrings are located at the rear of the thigh and extends the thigh and flexes the leg. Dorsiflexion of the foot is performed by the tibialis anterior.
Growth and Repair of the Muscles Muscle hypertrophy is the term used for when a muscle cell grows in size, and the commonest reason for this is due to exercise, where there will be an increase in the muscle fiber. When a muscle is damaged (torn), the body has to repair it and will do this by using satellite cells which fuse with the ends of the damaged fibre. If the damage is constant then the process will repeat itself so that more satellite cells are used which will create growth of the muscle. Muscle tone refers to the amount of tension or resistance to movement in a muscle. Muscle tone is what enables us to keep our bodies in a certain position or posture. A change in muscle tone is what enables us to move. For example, to bend your arm to brush your teeth, you must shorten (increase the tone of) the bicep brachii muscles on the front of your arm at the same time you are lengthening (reducing the tone of) the tricep brachii muscles on the back of your arm. To complete a movement smoothly, the tone in all muscle groups involved must be balanced. The brain must send messages to each muscle group to actively change its resistance. Tendons and Ligaments Tendons and ligaments are made up of collagenous tissue with ligaments attaching bone to bone and tendons attaching muscle to bone. The place where a muscle attaches to a bone but does not move, is known as the origin. To make movement occur, the muscles contract, which will pull on the tendons, this then pulls on the muscles. Tendons are tough, yet flexible bands of fibrous tissue, which allows movement. Ligaments are stretchy connective tissue which helps to stabilise the joints. They control the range of movements of a joint to prevent them from bending the wrong way. Injuries to both tendons and ligaments are very common, caused mainly by sporting injuries. It is fairly common for tendons to be stretched or torn which can be extremely painful. If ligaments are stretched, caused by injury or excess strain, the joint will become weaker, as the ligaments are unable to support it. As discussed, the muscles within our body act when they receive impulses. The nervous system is the means by which the body co-ordinates bodily systems and informs the body about any changes in the environment. The nerves carry brief electro-chemical messages that trigger appropriate responses in the various parts of the body. The messages (impulses) then react and will do certain tasks such as make the muscles contract, the glands secrete and the blood vessels widen or narrow.
The nervous system is a very complex system in the body but is divided up into two main parts. The Central Nervous System (CNS) and the Peripheral Nervous System (PNS). The CNS The Central Nervous System consists of the brain and spinal cord. The main function of this part of the system is to get information from the body and send out instructions and to maintain equilibrium in the body. The CNS receives sensory information from all parts of the body. On receipt of this information, the CNS analyses the information, and thoughts, emotions and memories are then generated and stored. The CNS usually responds to nerve impulses by stimulating muscles or glands, which creates an appropriate response to the original stimulus such as a change in temperature. The Peripheral Nervous System This part of the system is made up of all of the nerves and the wiring. This system sends
When a muscle is relaxed, there is a good flow of blood to the area, but during contraction, the flow of blood is reduced and therefore waste removal is limited. This is not a problem if this is occurring during exercise, as the constant contraction and relaxation allows the blood flow to remain. The problem can occur if we constantly contract the muscle without it actually moving, such as in sitting in a poor position, as the blood capillaries can become compressed and blood flow can be impeded, resulting in an accumulation of waste and a reduction in the delivery of nutrients and oxygen. Muscles can become fatigued and become weaker and can result in spasm, eventually creating pain. As the muscles become shorter, they will eventually pull on the tendons that attach them, which can result in loss of function and pain. As function gradually deteriorates, an imbalance can be caused in the muscle group and unless the action or activity that started the issue in the first place is not stopped, the problem will usually reoccur, even after treatment. If a client is presenting with a sharp pain, this can represent inflammation in the area and massage should not commence until the pain has turned into a dull sensation. Causes of
Postural Fault Definition Kyphosis is Excessive curvature at the top of the spine, creating a “hump” Scoliosis Curvature of the spine to one side, causing the hips to be misaligned. Lordosis Inward curve of the lower back, creating a protruding abdomen. As a therapist, you are not in the position to diagnose a postural fault but it is important to
The range of Motion (ROM) – Another way to carry out an assessment is to determine the amount of movement which occurs without discomfort or pain. If you are going to carry this out, demonstrate the movement to your client beforehand and always carry out checks on the unaffected side first, so that you have something to compare it to, then check for restriction or pain. This is purely as a guide and should not be used as a diagnosis, but can help you understand that muscles may be tight or restricted in a particular area.
Palpation – this is the process of feeling with your hands, sometimes before but definitely during the massage and it is a continual process throughout the treatment. Palpation will give you feedback on areas where you need to concentrate on and with lots of experience your fingers will begin to “see” what is beneath. During palpation, your fingers move the skin over the underlying tissues so that you are able to determine different textures. This procedure needs to be carried out very slowly. Below are some of the textures you may feel: Soft and pliable – this indicates healthy and relaxed soft tissue. Firm and stringy – will usually be tendons, due to their fibrous nature. Firm and less resilient – this can indicate thickening of the fascia. Dip in the contour of the muscle – this can represent a tear in the muscle. Woody and stringy and may “flick” – can signify adhesions of the fascia. Firm, gritty and fairly pliable – can indicate recently formed scar tissue. Firm, solid – can signify mature scar tissue. Knotty and resistant – this can indicate tension within a muscle. Fluid – if there is oedema in the soft tissues, the sensation can be soft and mobile, however if there is excessive fluid then the skin can feel tight, firm and be painful. Definitions of Soft Tissue Dysfunction Adhesions are fibrous bands that form around joints or within the fascia layers. They are formed from elastic fibres and are usually caused by inflammation or injury and the release of adhesive glycoprotein’s which aid the repair process. You may know adhesions as “knots”. Scar Tissue is the body’s natural response to injury, and its aim is to bring two ends together, for example in a torn muscle. It is also made of elastic fibres but also collagen and can be sticky in its early stages, causing the fibres to adhere together, causing muscle fibres to clump together over time and preventing the fibres from gliding. Scar tissue can become as hard as bone, and non-pliable reducing the Range of Motion in a joint. Generally, the earlier scar tissue is managed, the less damage it will cause. Fibrosis occurs when excess fibrous connective tissue forms usually due to tissue damage such as repetitive strain.
Muscle spasms are a convulsive muscular contraction which can be a result of tissue damage as the natural response is to contract nearby muscles. They can also occur if a muscle is overworked or overstretched. The contraction of the muscle fibers can compress on blood vessels and with a build-up of toxins in the muscle, the nerves can become irritated, causing pain.
DEEP TISSUE MASSAGE TECHNIQUES
Before any deep tissue work commences, it is essential that you warmed up the area by using plenty of effleurages as you would in a normal massage. You may find erythema occurring which can be a good indication that there is some congestion going on. Deep Stroking can be used within your standard effleurage, using the palms of your hands with the pressure coming from the heel of the hand rather than your fingers. Ensure you are not overstretching whilst performing this move, and you may find it beneficial to lower your couch to be able to apply pressure from your own body weight. Palpation should be taking place throughout the treatment, running the length of the muscle in slow motion. If you want to start working a little deeper, then you can re-in force your hand but ensure you are working slowly to identify any abnormalities in the tissue or muscles. Return to deep stroking throughout your treatment to encourage the removal of toxins and to keep the muscles warm. Petrissage can be used to lift tense muscles, only once you have applied plenty of deep stroking to the area. Deep Tissue Frictions can be carried out using the fingers, thumbs, the heel of the hand or even the elbow and can be performed in a number of directions such as circular or across the muscle (cross fiber friction). Frictions are ideally used where you suspect scar tissue or adhesions have formed, though they should not be used if you suspect an acute injury where there may be inflammation. Return to this technique throughout your massage rather than spending too long in one area as it can be too stimulating. Connective Tissue Manipulation (CTM) is a technique that involves stretching connective tissue using the soft pads of the fingers to move one layer of skin on the layer below. This technique is carried out easier if there is minimal medium being used so it may be necessary to remove any excess oil beforehand to prevent slip. Trigger Point Therapy is a technique that finds the “trigger point” within a muscle, tendon or the fascia that can be hypersensitive and can radiate pain to other areas of the body. This area can be as small as a pinhead, and the Trigger Point itself may not necessarily be the area of pain but can refer to the area where there is injury within a taut band of muscle and can act as a reference. The Trigger Point area can be congested spots within muscles, demonstrating restricted blood flow. Working on Trigger Points can reduce pain and improve circulation to the area.
Neuromuscular Therapy (NMT) or sometimes called Muscle Release Technique is an extension of trigger point therapy and is carried out on thick, knotty areas which are discovered through palpation. Direct pressure is applied, using either the thumbs or fingers or even elbows, directly on trigger points to break the cycle of muscular spasm to the area. Once the area has been identified, ask your client to take a deep breath and gradually apply pressure as they breathe out until it is just within their pain tolerance. It is therefore essential that the therapist works with the client to gauge this, and a scale of 1-10 can be used to determine how much tolerance a client has. The pressure can be applied for up to 90 seconds if necessary until the pain begins to ease or the therapist feels an alteration in the muscle. Once the pain has moved to a dull ache, carry out effleurage around the area to encourage circulation again. It is more effective to return to the area later on during the treatment, rather than use NMT for too long at a time as excess pressure can cause a muscle to go into spasm which would be counter-productive. If the pain increases rather than decrease during NMT, then the technique should be stopped immediately as there may be some inflammation present. NMT works on the theory that when a muscle is being regularly held in a wrong position and therefore carries tension, our brain starts to accept this as normal so that when we try and correct it, the brain feels as if it is wrong. This is not a conscious effort but happens through a natural reflex in the central nervous system. NMT works on a conscious level teaching the central nervous system that this is not normal and to re-programme it. The procedure temporarily compresses the blood vessels which supply the tissue, and when the compression is released, the blood will flow back to the area, bringing with it nutrients, oxygen and heat, and removing waste products. The release of endorphins also acts as pain relief. Cross Fibre Massage runs across the muscle fibers rather than the length of the muscle and is applied with the pads of the fingers or thumbs (usually reinforced). This technique is used in localized areas of tense muscles and can break down scar tissue effectively. Mechanical Massage can provide a consistent, deep and effective form of treatment. Many therapists like working this way as it can achieve the same results in around four minutes to what it would take manually in fifteen minutes, therefore saving the therapists hands and energy. Many therapists like working with the equipment as it is also less personal and maintains a consistent pressure. There are issues that need to be considered, however, such as loss of touch, making it more difficult to find areas of tension.
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
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