What Does Deep Tissue Massage Actually Mean? A Neuroscience Perspective
“I want deep tissue.” It's one of the most common requests massage therapists hear, delivered with the certainty that comes from knowing exactly what you want. But when we start examining what “deep tissue” really refers to, the concept quickly becomes slippery. Is it about how far into the body we press? The amount of force applied? A particular technique or strategy? How it feels to the client? All of the above?
Is It About Depth?
Let's start with the most literal interpretation: depth. Many reasonably assume that "deep tissue" refers to how far the therapist pushes into the body, and further assume that greater depth equates to greater effectiveness.
But depth depends on multiple factors, including tissue density, client size, and body region. In some areas deep structures are millimeters below the surface while other areas are composed of many centimeters of surface structures. Therefore, deep tissue can't be referring to absolute depth.
Is It About Pressure or Tools?
If it's not about depth, the next reasonable assumption is that it's about the amount of pressure being applied by the practitioner. But this, too, is unreliable. The "perfect" amount of pressure for one client may feel too little or too much to another. Similarly, some clients will say they don't want deep tissue but will request a lot of pressure, while others will say they want deep tissue but wince at moderate pressure.
In addition, some clients that request “a lot of pressure” are delighted with heavy compression applied broadly with forearms, while others with the same request aren't happy with this, preferring instead only moderate pressure with thumbs rather than “a lot of pressure” with forearms. Even if we fine-tuned the definition to “force per area”, we still find that there’s no objective value that works across people and body regions.
Pressure, like depth, doesn't seem to be the defining quality.
Perhaps instead it’s about specificity—hitting particular “spots” with precision. Or maybe it's about using particular tools or techniques: knuckles, elbows, forearms, cross-fiber friction, or pin-and-stretch. But these also don’t hold up, because clearly one can use any of these tools or techniques in ways that would not be "deep enough" for some clients, even when applied with specificity, and plenty of clients clearly want specificity while at the same time declining “deep tissue”.
So if it's not depth, pressure, tools, techniques, or specificity, what are people talking about?
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What Clients Actually Mean: “Good Pain”
In my experience, the common denominator in most “deep tissue” sessions is not an objective quantity like depth, pressure, or technique but rather the eliciting of the subjective experience that we often call “good pain.”
We could just leave it at that by saying deep tissue is just pointing to good pain, but I think we can dive a bit deeper into what good pain is all about. To do this, we need to discuss the neuroscience of nociception.
Nociceptive pain, the kind of pain that results from the activation of nociceptors, can be divided into two broad categories relevant to manual therapy: C-fiber nociception and A-delta nociception. C-fibers are primarily chemically responsive and produce sensations that are diffuse and achey, while A-delta fibers respond to significant mechanical inputs and produce sensations that are sharp and specific. When clients are seeking pain relief, they are mostly seeking relief from the pain emerging from C-fiber activation. Pain from A-delta fibers is what we get from daily bumps and scrapes.
So where does “good pain” fit into this? According to gate control theory, pressure and touch activate large-diameter A-beta fibers, which inhibit the transmission of signals from both A-delta and C-fibers at the spinal cord level. This is why rubbing a bumped shin provides relief, and why massage pressure can reduce achey sensations from C-fiber activity. But this raises an important question: if both light touch and deep pressure activate A-beta fibers, why does “good pain” feel qualitatively different than regular touch?
The answer likely involves which fibers are being activated. Light touch activates primarily A-beta fibers, producing a pleasant, non-painful sensation. “Good pain”, however, activates both A-beta AND A-delta fibers—the A-delta activation is what creates the sharp, distinct pain quality that makes it feel different from gentle touch. So “good pain” appears to require the simultaneous activation of A-delta signals AND the inhibition of C-fiber signals through A-beta activation (and possibly through descending modulation pathways from the brainstem). This explains why it feels DIFFERENT from light touch—because it actually hurts—but it doesn't fully explain why that combination feels GOOD or relieving.
Perhaps it's analogous to why some people enjoy spicy food: the capsaicin in cayenne pepper activates nociceptors and creates genuine pain, yet many find that sharpness enhances rather than ruins the eating experience. Similarly, the A-delta activation may provide a sharp, localized sensation that focuses attention to that location. Perhaps clients seeking “good pain” may be seeking A-delta activation strong enough to feel like pain, but not so strong that it overwhelms A-beta inhibition of C-fiber activity.
Contrary to what many think about “deep tissue”, the pressure used in these techniques does not change or fix the chemical situation in the tissue that was creating the C-fiber activity in the first place. We are simply inhibiting nociceptive signals temporarily through gate control mechanisms and possibly descending modulation. The C-fibers are still responding to the mostly unchanged chemical environment, so the relief experienced from the “deep tissue” treatment is temporary and may be occurring alongside tissue stress that could potentially lead to more C-fiber activity after the session. In other words, “deep tissue” can certainly make matters worse.
To summarize, the phrase “deep tissue” misses the point twice: it's not about depth and it's not about tissue. It's about activating A-beta fibers that inhibit C-fibers at the spinal cord while also activating A-delta fibers. Once we understand this, we can understand why depth, pressure, and technique seem relevant to the topic while also not being defining. We can also have a better grasp on why “deeper” doesn't mean better and might actually be creating additional tissue stress and C-fiber activity that potentially leads to a vicious cycle of wanting more deep tissue to override the pain caused by deep tissue. This is especially a concern with clients who have learned to tolerate the experience or dissociate from it, often because they errantly believe that deep tissue IS actually about both depth and tissue.
Experience vs. Tissue: What Really Matters
This distinction between experience and tissue reflects a critical tension between two ways of understanding bodywork. One is mechanical: we push, knead, or stretch tissue to supposedly correct something physical. The other is sensory-neurological: we provide input that changes how the nervous system feels, interprets, and regulates itself. The mechanical narrative persists because it's intuitive and visual—”breaking up knots,” “melting muscle,” “releasing fascia.” But research shows that tissue deformation during massage is minimal and short-lived, and that most therapeutic effects arise from the nervous system (Bialosky et al., 2009; Schleip, et al., 2003).
A simple thought experiment may help clarify further what deep tissue is and what it isn't: imagine a brain-stimulation device that could create the exact same pleasurable, relieving feeling as your favorite deep tissue massage, without any physical touch. Would you opt for this experience? If you're devoted to the outdated idea that the value of deep tissue actually has to do with manipulation of tissue, you might not use the device because it might seem it wasn't getting to the “real problem”. But if we understand the pain issue from a neural perspective and realize that what we're really after is the experience of having less pain, then such a device becomes appealing. Fortunately, deep tissue (and other forms of bodywork that don't engage A-delta fibers) can inhibit those pesky C-fibers, without needing this fancy brain device. We can modulate the brain’s activity via touch instead.
Seeing “deep tissue” as a perceptual experience changes how we practice. We don't need enormous force to create meaningful stimulation—a small but specific input can feel profoundly relieving. This understanding shifts our emphasis from technique to interpretation—from applying pressure to shaping experience.
That also means the words “deep tissue” are highly misleading and don't actually describe what makes the work effective. Contrary to its name, “deep tissue” actually points toward a sensory window in the nervous system—perhaps better named “deep sensation”—a place where strong but safe intensity feels productive rather than threatening.
Final Thoughts
This reframing doesn’t invalidate the practice of deep tissue—it clarifies it. What matters most isn’t how far or hard we press, but whether we engage the client’s nervous system in a way that feels safe, responsive, and effective (as is true for all forms of bodywork).
This awareness can make us better therapists and better communicators. When we stop trying to “go deep” and start trying to “feel right,” we reduce injury risk, improve outcomes, and honor how profoundly the nervous system shapes experience. What feels deep isn’t a matter of depth or pressure—it’s about how the brain interprets and responds to what it receives. In the end, it’s not muscles we’re working with—it’s perception itself.
References
Bialosky, J. E., Bishop, M. D., Price, D. D., Robinson, M. E., & George, S. Z. (2009). The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model. Manual Therapy, 14(5), 531–538.
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Koltyn, K. F. (2014). Mechanisms of exercise-induced hypoalgesia. Journal of Pain, 15(12), 1294–1304.
Liljencrantz, J., & Olausson, H. (2014). Tactile C fibers and their contributions to pleasant touch. Frontiers in Behavioral Neuroscience, 8, 37.
Lund, I., & Lundeberg, T. (2008). Is it all about sex? Acupuncture for the treatment of pain from a biological and gender perspective. Acupuncture in Medicine, 26(1), S7–S14.
Mense, S. (2003). The pathogenesis of muscle pain. Current Pain and Headache Reports, 7, 419–425.
Ochoa, J., & Mair, W. G. (1969). The normal sural nerve in man. Acta Neuropathologica, 13(3), 197–216.
Schleip, R. (2003). Fascial plasticity – a new neurobiological explanation. Journal of Bodywork and Movement Therapies, 7(2), 104–116.
Author
Dr. Mark Olson holds an M.A. in Education and a Ph.D. in Neuroscience from the University of Illinois, specializing in cognitive and behavioral neuropsychology and neuroanatomy. His research examined memory, attention, eye movements, and aesthetic preferences. He is a NARM® practitioner, aquatic therapist, former director of the Pacific Center for Awareness and Bodywork, and a published author on chronic pain and trauma-informed care. He teaches courses at Dr-Olson.com that bring neuroscience and relational skill-building together to help people understand themselves—and each other—with more clarity and compassion.
