This week’s FAQ Friday turned into FAQ Saturday due to a very busy schedule yesterday. This week’s question: Is deep tissue more effective than other types of massage, and what do you suggest for clients who love deep pressure?

The quick answer: nope, deep tissue is not more effective than other types of massage. In the past we believed that pain in the body was usually an “issue in the tissues” and by massaging the body we were releasing tension and adhesions and helping to correct these “issues in the tissues.” We now understand that massage appears to be beneficial because it can help sooth the nervous system, sending signals to the brain saying, “hey, we’re safe, so you can dial down those feelings of pain or tension.” The brain then sends the signal back to the body, decreasing those negative feelings of pain or tension. It’s the brain that creates these sensations (pain is an OUTPUT from the brain), and it’s the brain that can decrease these sensations. It really isn’t an “issue in the tissues” so there no need to smash and bash the muscles trying to relax them by creating pain. 

It is suspected that massage that is too deep may contribute to central sensitization, which is essentially a hypersensitivity to pain. If the body views deep massage as pain, for example, it can cause there to be more pain with less provocation.  Pain can create changes to the central nervous system, which can make a person more sensitive and can create more pain. A deeper massage could create temporary relief of your pain but also create sensitization causing more pain and issues in the long term.

If you enjoy pressure that “hurts so good,” and find relief with this type of pressure, I suggest trying Ashiatsu. With Ashiatsu, I use my feet to apply broad pressure. The pressure can be anywhere from very light to very deep, but the nice thing is that by using feet, the pressure isn’t “pointy” like using an elbow or fingertips.

Many of my long term clients have made the switch from deep pressure to pressure that is lighter and more soothing to their nervous system. They’ve found that this switch has allowed them to have better results with a longer duration of relief. I often throw in a type of bodywork called Dermoneuromodulating (or DNM for short). This type of work consists of slow, gentle stretches to the skin which the body tends to find very therapeutic and relaxing. I also suggest trying a Hot Stone Spot Treatment where I massage one or two trouble areas with heated stones. The body seems to enjoy the novel sensory experience of the heat, and it does feel incredible!

One very important point to mention - regardless of the type of massage you receive or the depth of that massage, if there is ever any discomfort or pain PLEASE don’t be afraid to speak up and let your massage therapist know. I promise that it won’t hurt my feelings, and it’s important that you do not leave your massage feeling worse than when you came in. 

Massage during pregnancy FAQ
 
Can you receive a massage during the first trimester of pregnancy?
There are very few (if any) reasons why a pregnant woman couldn’t be massaged during all phases of pregnancy. Many massage therapists choose not to massage during the first trimester due to the  increased risk of miscarriage. It’s so incredibly unlikely that the miscarriage could be due to the massage that I’ve never once heard of it happening.  Of course many massage therapists don’t want to risk it, in the fear that a grieving mother might blame the massage they received.  In my opinion that just increases fear unnecessarily. Massage can be great for calming nerves (literally and figuratively 😊), and helping a momma relax during a time of profound change.

Pressure Concerns:
During pregnancy there is an increased risk of blood clots. For this reason, massage on the legs should be gentle, not just during pregnancy, but up to 6 – 12 weeks postpartum. Deep tissue work on the legs would not be recommended. Massage of the abdomen should also be gentle, should you want your belly massaged. (A lot of people are uncomfortable with it but it feels wonderful!)

Acupressure Points:
According to traditional Chinese medicine, there are acupressure points located throughout the body (the most well-known being on the ankles) that when pressed can stimulate labor. Western medicine has zero concerns about any of these areas, but I respect if my clients have these beliefs. However, in order to even have a chance of activating these points, you’d need prolonged pressure in very specific spots, and those are two things that won’t happen during a massage. So go ahead and have your feet and ankles massaged!

Heat:
Heat is generally frowned upon when pregnant, and during massage we don’t want to do anything to increase the core body temperature beyond 102 degrees. Honestly unless the room is sweltering, I can’t imagine anything in a standard massage that could cause such a temperature spike.  A table heater set low/medium is fine (as long as it’s comfortable), and even warm stones are OK. I personally skip putting hot towels on the back or doing a hot towel foot wrap during pregnancy, but chances are good that even those would be OK. (I like to play it safe.)

Swelling:
Swelling is very common in pregnancy especially during the third trimester. Massage is still appropriate unless you have pitting edema (where you press into the skin and it stays indented for a few seconds). With pitting edema, you should see your doctor to make sure there are no complications such as preeclampsia. During both pregnancies I had bad swelling and pitting edema up to my belly!  My doctor couldn’t explain the swelling, but I was still cautious and did not receive massage on my legs.

Complications:
For virtually all pregnancy-related complications massage may be appropriate, but may need to be extra gentle and a shortened duration. You don’t want to tax the body any further, but the relaxation aspect of a gentle massage can be profoundly calming during a stressful time. Please choose a massage therapist with advanced prenatal massage training. Should a new issue crop up prior to your massage (sudden headaches, bleeding, etc.) please make sure you see your doctor before you receive massage to rule out anything serious. Massage should not be used in place of standard health care.

Positioning:
Once a client is 20+ weeks (or when lying face up or face down is no longer comfortable), I prefer to have them in a side-lying position, supported with pillows (just like sleeping at night), and possibly semi-reclined with a big wedge pillow. Some massage therapists use a special pregnancy table, but I’m personally not keen on them since they are a one-size-fits-all and can allow ligaments to stretch as the belly hangs poorly supported. There are also pregnancy pillows that can be used. It’s a lot of fussing around, but some people love them.

Morning Sickness:
If you have it, you probably are unlucky enough to know it can happen ANY time of day, not just morning. And it doesn’t always end after the 1st trimester. Discuss your concerns with your massage therapist. I tend to be more flexible with my pregnant clients and clients with cancer, because nausea and vomiting can hit at inopportune times and prevent you from making it to your appointment.  If you’re sensitive to certain smells, it’s OK to mention it before your appointment so your massage therapist can try to keep the room scent-free.

Stretching:
Ligaments become more lax during pregnancy and stretching should be done with caution. For some people it feels heavenly, for others like myself, it was torture and caused immense soreness and pain.

If you have any questions or concerns about pregnancy and massage, don’t be afraid to reach out to your massage therapist. Just like for non-pregnant clients, it’s OK to call and ask how they’d proceed with the massage for whatever condition or concern you have.