Key takeaways.
Deep tissue massage is slow, firm pressure aimed at deeper muscles. It should feel like a strong ache you can breathe through, never sharp or burning pain.
- Firm pressure suits tight, overworked muscles in the back, hips, shoulders and legs.
- Pain you cannot relax into makes the muscle tense up and works against the goal.
- Mild soreness for a day or two is common. Bruising means the pressure was too much.
- Firm work is not used over clots, fractures, wounds, infection or fresh surgery.
- ICBC and health plans pay for RMT visits, whatever the technique.
What deep tissue means in a clinic.
Muscles sit in layers. The muscles you can see under the skin cover deeper ones that hold your spine, hips and shoulder blades in place. Deep tissue massage uses slow, firm pressure to reach those deeper layers. The strokes are slower than in a relaxing massage, and the therapist often focuses on one muscle at a time.
In a clinical session it rarely runs alone. A Registered Massage Therapist usually starts with lighter strokes to warm and relax the area, moves to firmer work where the check found tight or tender muscle, and finishes with lighter strokes again. Steady pressure on a tender spot, often called trigger point work, and slow work on the tissue around muscles are part of the same toolkit.
Good pressure versus too much.
Use these signs during the session:
- Good: a strong, spreading ache. You can breathe slowly. The muscle softens under the pressure.
- Too much: you hold your breath, clench your jaw, or lift your shoulders off the table.
- Stop: sharp, burning, electric or shooting pain, or numbness and tingling down a limb.
When pressure is past what you can relax into, the muscle tightens to protect itself. The therapist then pushes against a guarding muscle, which is harder work for both of you. Speaking up helps the treatment. Saying “lighter, please” or “you can go firmer” is the most useful feedback you can give.
What the research shows.
Most trials of massage for pain mix several methods, so it is hard to isolate deep tissue work. The larger picture is useful, though. A 2015 review in the Journal of Physiotherapy pooled 26 trials and 2,565 people and found massage reduced pain in the short term compared with no treatment for shoulder pain and knee osteoarthritis, and improved function for low back pain, knee arthritis and shoulder pain.
For tender spots in the neck, a 2015 trial of 56 people with tension-type headaches gave 12 trigger point massage sessions over six weeks. Massage raised the pressure people could tolerate on those spots in every muscle tested, and the fake treatment group did not show that change. Headache frequency fell in both groups, which shows how much expectation matters in pain studies.
A 2024 review in JAMA Network Open mapped 129 reviews of massage for pain. None of their conclusions were rated high certainty, and every conclusion rated moderate certainty found massage helped pain. Fair summary: massage can ease pain for a while, and it works best as part of a plan that includes movement.
The next day.
Expect mild soreness after firm work, like after a workout. The 2015 Cochrane review on low back pain found that more pain after treatment was the most common side effect, in 1.5% to 25% of people, with no serious side effects in those trials. Gentle movement such as a walk helps more than lying still.
Call the clinic if soreness lasts more than two days, if you see a large bruise, or if you feel numbness or tingling that was not there before. Go to Lions Gate Hospital emergency or call 911 if one calf becomes swollen, hot and painful, or if you become short of breath.
When firm pressure is the wrong choice.
Some health problems change the pressure or rule out firm work in an area. These include a known or possible blood clot, a fracture that has not healed, an open wound or skin infection, surgery that your surgeon has not cleared, blood thinners, a low platelet count, and osteoporosis. A 2003 safety review in Rheumatology found most reported harms came from unusual massage methods or untrained people, and that serious harms are rare. Our safety page covers each case.
Where deep tissue work fits at Medstar.
Kevin Herter, the clinic's Registered Massage Therapist, uses firm work when the check shows a tight, overworked muscle and you are comfortable with it. Common reasons people come in include tight hips and calves from running, stiff upper backs from desk work, and low back tension. See our pages on low back pain and sports massage for more.
Deep tissue questions.
What is deep tissue massage?
Deep tissue massage uses slow, firm pressure to reach muscles that sit under the surface layer, such as the deep muscles of the low back, hips and shoulder blades. The strokes are slower than in a relaxation massage, and the therapist often works across or along one muscle at a time. At Medstar it is one method a Registered Massage Therapist chooses based on your assessment.
How hard should deep tissue massage feel?+
It should feel like a strong ache that you can still breathe through slowly. Sharp, burning, electric or shooting pain is the wrong kind, and you should say so at once. If you are holding your breath, clenching your jaw or tensing up, the pressure is too much for that muscle on that day.
Does a more painful massage work better?+
There is no good reason to think so. When pressure is too strong, people tense the muscle the therapist is trying to soften, which makes the work harder. Bruising and days of soreness are a sign the pressure went past what your tissue could take. A skilled therapist builds pressure slowly and stays at a level you can relax into.
Is it normal to be sore after deep tissue massage?+
Yes, mild soreness for a day or two is common after firm work, and feels like the day after a workout. The 2015 Cochrane review of massage for low back pain found more pain after treatment was the most common side effect, in 1.5% to 25% of people across the trials, with no serious side effects reported. Soreness lasting beyond two days should be reported.
Can deep tissue massage cause bruising?+
It can, especially in people who bruise easily or take blood thinners. Bruising usually means the pressure was more than that tissue could take. Tell your therapist if you take a blood thinner, aspirin, or fish oil, or if you bruise easily, so the pressure can be set for you.
What is the difference between deep tissue and Swedish massage?+
Swedish massage uses longer, flowing strokes at lighter to moderate pressure and aims to relax the whole body. Deep tissue massage uses slower, firmer pressure focused on specific tight muscles. In practice, a clinical session often uses both: lighter strokes to warm and relax the area first, then firmer work where it is needed, then lighter strokes again to finish.
Who should avoid deep tissue massage?+
Firm pressure is not used over a known or possible blood clot, a recent fracture, a new wound or infection, or an area with recent surgery that has not been cleared. People on blood thinners, people with low platelet counts, and people with osteoporosis need lighter work. Pregnancy changes positions and pressure. Tell your therapist about all of these before treatment starts.
Is deep tissue massage good for knots?+
Many people feel tight, tender spots in muscles and call them knots. Steady pressure on these spots, often called trigger point work, can ease the tenderness for a while. In a 2015 trial of 56 people with tension headaches, trigger point massage of the neck raised the pressure people could tolerate on those spots, and the placebo group did not show the same change.
Can I ask for deep tissue massage on my first visit?+
You can ask, and your preference counts. The therapist will still start with your health history and a check of the area, then build pressure slowly to learn how your tissue responds. On a first visit, a therapist usually starts with moderate pressure, because they cannot yet know how you will feel the next day. Pressure can go up at the next visit.
Does ICBC or my health plan cover deep tissue massage?+
Plans and ICBC pay for registered massage therapy visits. They do not pay by technique. Deep tissue work is part of a normal RMT visit, so it is covered the same way as any other massage therapy session. ICBC pre-approves 12 massage treatments in the first 12 weeks after a crash. Work health plans cover RMT visits up to the limits in your plan booklet.
Sources.
Checked November 5, 2026.
- Bervoets DC, et al. Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review. Journal of Physiotherapy, 2015. 26 trials, 2,565 people. PMID 26093806.
- Moraska AF, et al. Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial. Clinical Journal of Pain, 2015. 56 patients. PMID 25329141.
- Mak S, et al. Use of massage therapy for pain, 2018 to 2023: a systematic review. JAMA Network Open, 2024. 129 reviews found. PMID 39008297.
- Furlan AD, et al. Massage for low-back pain. Cochrane Database of Systematic Reviews, 2015. 25 trials, 3,096 people. PMID 26329399.
- Ernst E. The safety of massage therapy. Rheumatology, 2003. 16 case reports and 4 case series. PMID 12777645.
- ICBC. Accessing treatment during your first 12 weeks of recovery (pre-approved treatments table, treatments April 1, 2026 to March 31, 2027).
Registered massage therapy at 1325 Marine Drive
Book with Kevin, or call and ask whether massage fits your problem.
Reviewed by Kevin Herter, RMT, Registered Massage Therapist at Medstar Sport Physio & Health, who provides massage therapy at the clinic.
This page gives general information and is not medical advice. Whether massage suits you is decided at your visit, after your history and health questions. If you have chest pain, sudden weakness, a sudden severe headache, or a swollen, hot, painful calf, call 911 or go to Lions Gate Hospital emergency. Massage therapists in BC are regulated by the College of Complementary Health Professionals of BC, where you can check any therapist's registration.