Clients are often asked if they want a “Swedish” or “deep tissue.” These terms, however, can misinform them about what massage therapy actually provides.
Recently, a client asked me what is the difference between “Swedish” and “deep tissue” since she often gets asked about that when she books an appointment at a spa. She wasn’t the first client to ask me about that; at least a dozen have asked me the same question for more than five years. There isn’t a straight answer to this because I am uncertain about how massage therapy is boiled down to two modalities for clients to choose.
There is very little reliable information online about the origin of the term Swedish massage, but I think there may be a few old books on massage therapy that provide such documentation. A quick search on PubMed mostly yields on how effective Swedish massage is for a condition when it is pitted with another modality. The most reliable source I could find so far is from an acupuncture and massage college in Miami, Florida, that goes into details (with pictures) about the origins of Swedish massage. I’m not sure how reliable this source is, but it is a start.
Since I had worked in spas for more than five years, I heard these terms often. Clients are often left with the impression that this all there is to massage therapy. Light or deep. Or somewhere in the middle. The terms are rather ambiguous because the amount of pressure one prefers is quite subjective. What is considered “deep” for one person may be the opposite end of the spectrum for another.
Swedish massage consists of repetitive strokes often performed by using the therapists’ hands. Speed, duration, and pressure can vary, which depends on the recipient’s preference. Sometimes the therapists use their forearms or thumbs for specific body parts like the entire back, hands, and feet.
Deep tissue is an ambiguous term that can encompass many modalities. Some therapists may argue that it is a “meaningless term” because the degree of deepness one prefers or tolerate can vary a lot, as mentioned earlier. Nearly all modalities can be “deep,” so there is no single modality that owns the term “deep.”
Also, there is a risk of injury if a therapist applies too much pressure, such as rhabdomyolysis, a medical condition where skeletal muscle cells break down myoglobins and they leak into the bloodstream. This often happens when someone suffers from blunt trauma. While such cases are rare in massage therapy, it is still possible for deep pressure massage to cause rhabdomyolysis, such as the case with an 88-year-old man in Taiwan who received extremely deep work from two new massage therapists, one hour from each therapist. (1)
Rather than focusing on the type of massage or pressure, I would prefer to listen to what clients say about their experience and why they come to see me.
Let your problem guide the treatment, not the other way around.
When therapists focus on the modality or specific technique, the approach narrows their scope and thinking. They may try to fit the clients’ problem into the lens of their modality or technique. It is similar to a personal trainer who focuses on kettlebell training, Olympic lifting, or any specific tool or modality of training rather than understanding the problem or goal that the clients have. It is sort of like this cartoon, “Doctors and Fat Patients” by Barry Deutsch.
This issue brings back the “operator versus interactor” concept that was published in The Journal of Manual & Manipulative Therapy in 2011 by Diane Jacobs and Dr. Jason Silvernail. The traditional approach to massage therapy or in any manual therapy—the operator—is where the patient is treated as a passive recipient while the therapist gets credit for the treatment outcome, especially if it is a positive one.
The interactor approach takes into the context of the treatment greater than the treatment alone. It considers the interaction between the therapist and the patient or client, the treatment environment, expectations and beliefs from both parties, culture, and language. The interactor approach also allows the patient or client to have more locus of control of their condition and increases the likelihood of forming alternative narratives and beliefs about it.
In fact, the interactor approach seems more aligned with narrative medicine, which focuses on the patients’ or clients’ understanding of their problem, their story behind the problem, and exploring their narrative. While this approach is akin to what family therapists and counselors do, for manual therapists, we do not cosplay such professionals and step over our boundaries. Instead, therapists can use narrative medicine as a framework of improving communication, which would likely improve hands-on care.
A Better Way to Ask What You Want From Massage Therapy
Instead of focusing on modalities, redirect the attention to the problem itself. This can help both the therapist and the client find out what approach is best for the problem rather than using a cookie-cutter shortcut. There are times when new clients think they need deep tissue work, but in fact, they find gentler work to be more helpful for their pain and stress.
Massage therapy is more than just about pressure. Current evidence (although most of massage therapy research are quite weak and low quality) indicates that massage therapy can alleviate symptoms of depression and anxiety (3), knee osteoarthritis, and low back pain, even if it is temporary. But that temporary effect may help jump start a long journey to recover, even if it means three to four days of extra sleep and better work performance.
Every person I see has a unique story to why they come to see me and other therapists. By understanding your condition and hearing you out, we can proceed to the right treatment specifically for you.
Notice that the stiffest tree is most easily cracked, while the bamboo or willow survives by bending with the wind.~ Bruce Lee
1. Lai MY, Yang SP, Chao Y, Lee PC, Lee SD. Fever with acute renal failure due to body massage-induced rhabdomyolysis. Nephrol Dial Transplant. 2006 Jan;21(1):233-4. Epub 2005 Oct 4.
2. Jacobs DF, Silvernail JL. Therapist as operator or interactor? Moving beyond the technique. J Man Manip Ther. 2011;19(2):120–121. doi:10.1179/106698111X12998437860794.
3. Moyer C. Affective Massage Therapy. Int J Ther Massage Bodywork. 2008; 1(2): 3–5.
4. Perlman A, Fogerite SG. Efficacy and Safety of Massage for Osteoarthritis of the Knee: a Randomized Clinical Trial. J Gen Intern Med. 2018 Dec 12. doi: 10.1007/s11606-018-4763-5.
5. Mahdizadeh M, Jaberi AA, Bonabi TN. Massage Therapy in Management of Occupational Stress in Emergency Medical Services Staffs: a Randomized Controlled Trial. Int J Ther Massage Bodywork. 2019;12(1):16–22. Published 2019 Mar 4.