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Any soft tissue
mobilization provided by the hands we traditionally call massage therapy.
The goals of most technical approaches of massage procedure (mobilizing
skin, fascia, muscles, periosteum etc.) are to release tension within
muscles and fascia, to increase blood supply to the tissues, and to cause
multiple positive changes in the functions of organs and systems. We all
know that our body consists of superficial as well as deeply located
muscles, fascia and other tissues. In my opinion, deep massage therapy is
not a separate modality but must be part of any clinical work whether it
is stress management massage, orthopedic massage, sports massage etc.
As I stated above, massage therapy consists of mobilization of
skin, fascia, muscles, and trigger point therapy (if trigger points are
present). Speaking generally, the goals of massage therapy are to release
tension in the fascia/muscles alliance, to increase blood supply to the
tissue, to break down any pathological accumulations such as calcification
of soft tissue and stimulation of their removal from the body, management
of scar tissue, including scar tissue that formed due to microtrauma
(example: professional athletes as well as enthusiastic fitness
enthusiasts training like pro athletes, who due to constant extreme
exercise, cause microtrauma to the soft tissues with resulting multiple
scar tissue formations which cause adhesive stickiness to develop in the
tissue losing its elasticity) to stimulate endorphins production, to block
pain analyzing system, etc. In order to achieve the above-mentioned goals,
deep tissue mobilization must be performed.
Physiological effect of massage on the human body
Two factors define the physiological effect of
massage on humans.
1. Local, mechanical factor - expressed by
mechanical acceleration of venous blood drainage, some degree of lymph
drainage acceleration, passive exercise for soft tissues, and breaking
down deposits of calcium in soft tissue and stimulation of its removal
from the body.
2. Reflex factor - There is no doubt that the main
power of massage therapy is as a reflexive therapy. By mobilizing skin,
connective and muscular tissue, we deform the proprioreceptors which in
turn creates action potentials (electrical activities) that through
neurological pathways reaching motor and vasomotor centers. As a reflex
(involuntary reaction of organs and systems to original stimuli) the body
responds by expressing all positive changes that I mentioned earlier.
To ensure that we are achieving the most profound physiological
effect on the body of the client possible, massage should be performed as
deep as possible. The deeper we massage, the more we stimulate the nervous
centers, and the more and faster the reflexive therapeutic effects will
occur,bigger amount
of endorphins production,ext
Deep Tissue Massage
4 strategies:
1. To work in the
inhibitory regime
In order to reach safe rapid and
sustained results for neuromuscular disorders or for stress management, we
must perform massage in the inhibitory regime. Every nerve receptor has
its own level of adaptation, which means its capability to produce
electrical activities (also known as impulse or action potential). The
rhythm of massage strokes should be about 70-80 movements per minute and
the technique application on the massaged area should be prolonged while
gradually increasing pressure and minimizing disconnection. This produces
a massive amount of nervous impulses that travel to and excite
corresponding nervous centers. With the prolonged application of the
massage techniques, the nervous centers become inhibited by the massive,
continuous flow of afferent electrical impulses from the massaged area.
Performing massage in inhibitory regime, eventually not increasing
production of action potential, but the flow of afferent neural impulses
from the contact area of our hands will continue. At this point, the
membranes of the nervous cells become repolarized; unable to generate or
conduct efferent impulses, and as a result, the tension in the soft
tissues of the massaged area is reduced. Reflexively, the body responds by
vasodilation, a reduction of pain sensation and muscular relaxation. This
approach aims at reducing the sympathetic tone and restoring balance
between the sympathetic and parasympathetic divisions of the autonomic
nervous system.
As we continue to apply inhibitory techniques to a
massage area, the more superficial soft tissues relax, allowing us to work
into deeper and deeper layers of tissue. The deeper we mobilize, the
greater the amount of receptors we can stimulate. The more receptors we
stimulate, the more we ensure that our performance may achieve the maximum
therapeutic effects.
2. Shift superficial
tissues to expose deeper layers
Sometimes it is
only possibility to get to the deeper layers of muscles and other soft
tissue, is simply moving the superficial tissues out of the way. The
superficial soft tissues in some areas must be shifted in order to reach
the deeper layers. One example of this strategy is in the medical massage
treatment for piriformis muscle syndrome. In the treatment of this
challenging disorder, we must directly massage the piriformis muscle (a
very deep muscle; originating on the anterior portion of the sacrum and
inserting into the greater trochanter). In order to access this very deep
structure, we must first medially shift the gluteus maximus muscles and
hold them out of the way while we apply massage techniques on the
piriformis muscle.
3. Compression; shifting
superficial tissues followed by transmission of pressure to the deeper
layers
The additional strategy for deep tissue
mobilization is to utilize techniques for compression of tissue. In this
case, the transmission of pressure thru the superficial to the deeper
layers of tissue will significantly contribute additionally to the release
of tension in fascia and muscles as well as stimulate the production of
endorphins, etc. There are many benefits to using deep compression
techniques in massage therapy. Of the mechanical factors, compression
techniques allow us to gradually tear down any deposits of scar tissue, or
in the case of chronic inflammation, adhesive scar tissue and/or soft
tissue phenomena.
Piezoelectrical Effect of
Massage Therapy
Both inorganic and organic
substances have the ability to generate electrical potential in response
to pure mechanical deformation. This is referred to as the piezoelectrical
phenomenon. During the performance of massage therapy, we are deforming
the tissues, cells, and molecules thereby generating/creating
piezoelectrical charges. In massage, the main cause of piezoelectric
phenomenon is the deformation of collagen molecules. One should remember
that elastin and keratin also carry piezoelectric properties. As we know,
our molecules are surrounded by large amounts of extracellular fluid (at
least 70-75% of our body is water). By performing massage therapy we not
only generate electrical impulses that travel thru peripheral nerves which
conduct their way to the central nervous system, but also piezoelectrical
charges of electricity. These piezoelectric charges move out in all
directions, thru extracellular fluid and other molecular structures,
creating streaming potentials that travel to the inner organs and there
create massive additional afferent impulses. These afferent impulses from
the inner organs in turn further stimulate centers within the central
nervous system and increase the power of reflexive therapy (positive
changes in function of organs and system due to original stimulation by
massage).
4. Performing massage under
stretching of the muscle
In some cases when we are
trying to massage the deeper layers of soft tissue, it is helpful and
sometime even necessary to first stretch the superficial structures before
applying massage techniques to the region. For example, when performing
massage therapy in cases of TMJ disorders, we must massage all masticatory
muscles as deeply as possible. During treatment, we hold the client’s jaw
open to expose the belly of the masseter muscle and other chewing muscles.
Sometimes, clients can develop functional limitation of range of
motion for different reasons. For example, after surgery or immobilization
of a joint due to a break, or some chronic inflammatory condition, muscles
can develop a state of contracture ( for example in the knee region,
deficit of extension/flexion). Over time, continuation of this condition
can lead to the muscles and tendons becoming functionaly shorter. When we
stretch out the structures and apply massage while the structure is under
stretch, not only will it encourage the restoration of normal length and
elasticity, but it also allows for much deeper mobilization.
How much pressure should be applied?
Nowadays, some massage therapists make no
distinction between the concepts of strong massage and deep massage. Most
of us agree that strong massage will not always be deep massage. There is
no doubt that when we perform deep tissue massage it feels stronger. The
question is how much pressure should we be applying?
In order to
reach results, and to avoid injury from applying strong pressure, we must
utilize the following rules. 1. Pressure has to be significant (gradually
increasing to the maximum extent) but must avoid activating the pain
analyzing system. Given the fact that pain is a somewhat subjective
sensation and cannot be measured like weight, or blood pressure, we have
to design the pressure by consulting our client. The moment when the
individual’s threshold of pain is determined, the therapist can properly
increase pressure to the determined level. 2. If the applied pressure
causes protective muscular contraction reflex, and even if the client
encourages you to continue or increase it, you must reduce the pressure
and restart the process of gradually increasing pressure to the maximum
point that will avoid muscular reflex contraction.
If we will
apply very strong pressure that will activate the pain analyzing system
(activation of the pain analyzing system causes reflexive protective
muscular contraction) and will continue to vigorously perform the massage,
this kind of act actually traumatizes the muscles, causing inflammation of
the muscles and following development of trigger points within the muscles
and other difficult pathologies of muscular system. By gradually applying
pressure we not only avoid injuring the client, but as you understand, we
also relax the superficial layers of tissue that allow us to mobilize the
tissue to the deepest possible extent.
In
Closing
Whenever performing massage for
therapeutic purposes, it is imperative to mobilize tissues as deeply as
possible. However, we must never force the way to go deep. Remember the
protocol for application of pressure; it must be significant, but without
activating the pain analyzing system. We can mobilize only as deep as the
body will allow us to. As you understand from my article, to create
conditions for deep therapeutic massage is a only guidelines for the deep
tissue massage
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