• Deep Tissue with Purpose

    Posted on October 22, 2013 by Dawn in Questions and Answers.

    Originally published in Massage Magazine, June, 2012 – written by Dawn Lewis

    Deep tissue massage could be defined as a set of moves designed to get the therapist into deeper tissues, or it could be defined as a variety of strokes meant to treat a specific area of pain.  Then again, deep tissue could be defined as any technique that allows the therapist to contact and effect any deep tissues.
    I generally think of deep tissue as the latter of these three definitions.  Traditional deep tissue massage is a go-to modality for many therapists, including myself.  But through the years of practicing I have come to understand that deep tissue without purpose can wind up causing only pain.
    Many times when a therapist finds an area of adhesion or tension, he/she tries whatever modality  he/she is trained in.  If the adhesion or tension does not dissolve with whatever techniques the therapist is using, the fallback is deep tissue.  But not deep tissue with a purpose, simply deep tissue because they do not know what else to do.  This generally does not have productive results.
    The question then becomes how can we get deep into the body’s tissue effectively and without causing pain, in a way that will resolve the issue in the area and have long lasting effects?  How can we use our beloved deep tissue in a highly productive fashion?  There is a way.  The technique is called Spontaneous Muscle Release Technique or SMRT.
    I began developing SMRT after hearing the premise for Modality C (which I cannot name because they have informed me that I do not have permission to name their modality on my website).  Several months later, I took Modality C courses, but found that I was already ensconced in SMRT.  While SMRT is similar to Modality C in concept, Modality C focuses on trigger point release, while SMRT allows trigger point resolution to happen naturally through release of specific tissues in any given area.  The simplest way to describe SMRT is that it is passive contraction of tissue.
    The benefits to clients are  wonderful.  One of the most amazing things I find with SMRT is that I can get into the deeper tissues of the body without causing the client pain.  When I find an area that is tender I think about what tissues I am contacting, I move these structures into a position of passive contraction and I hold for 30 seconds.  This is what we call an SMRT release or position.  One of the ways that the passive contraction of an SMRT position affects the area being worked is by increasing the flow of blood.
    Additionally, the SMRT position will speak to the proprioceptors of the muscles being worked, telling the proprioceptors that the amount of tone the structure has been holding is no longer necessary.  This is done by passively contracting to within the first 10% of possible contraction.  The proprioceptors then communicate with the nervous system, bringing the attention of the nervous system to the area.  These messages given to the body during an SMRT position then allow the muscle to release tone, move out held toxins, and move toward homeostasis.
    All of this removes tenderness in the area and allows me to get into the deeper tissues.  “You get into the tissue on a deeper level.”  Erin, a chiropractor who is a client of mine said.  “The last therapist I had never got as deep as you do and it was painful.  I just took deep breaths and endured, but the treatment didn’t last as long as my work with you and he was never as deep.”
    One of the greatest barriers for massage therapists in performing deep tissue is client tenderness.  Some therapists try to push past that tenderness, hoping the tenderness will improve once the deeper tissues are contacted.  Still other therapists, responding to their client’s pain, pull back and never reach the deeper tissues in that client’s body.  By doing an SMRT release in the area of tenderness, it is possible to respond to your client’s pain and reach the deeper tissues of the body.
    As an example, let’s use Marti and her right axilla.  Marti has had an expanded lymph node under her right arm for the past 30 years.  Every couple of weeks Marti’s shoulder goes into “lockdown”, she says, and feels thick and unmovable.
    Palpation of Marti’s axilla reveals a wall of subcutaneous connective tissue that seems determined to protect everything behind it.  The tissue is like a trampoline, you can push into it, but it will only bounce you right back out.  Too much digging only produces inflammation and more pain for Marti.  “I had been to several massage therapists who would become frustrated and just dig.  It hurt so bad, I didn’t go back for massage for several years.”  Marti says.  “This method really works for me though.”
    The reason the axillary connective tissue is so tight and restrictive in Marti’s right axilla is that the enlarged lymph node in the right axilla tends to adhere to both pectoralis major and serratus anterior.  I begin Marti’s session by doing a release for the adhesion between the two muscles.  By compressing the anterior ribcage and moving it superior and lateral, both muscles are effected and both muscles release tone.  Because this SMRT release is targeting both muscles and increasing blood flow and nervous system awareness in both muscles, the adhesion melts away and the lymph node is released.
    This allows me to get deeper into Marti’s axilla.  Once the superficial tenderness has been alleviated and pectoralis major and serratus anterior, along with the superficial connective tissue, have been released, the deeper tissue is accessible and eager to be touched.  In addition to releasing both of these muscles, the passive contraction stimulates the lymphatic system.  This creates fluid movement in the lymphatic system, which alleviates inflammation in the area, while unadhering the expanded lymph node directly helps the flow of lymph fluid through that lymph node.
    So, why does Spontaneous Muscle Release Technique stimulate and enhance lymphatic system flow?  The mechanism for pumping lymphatic fluid through lymphatic vessels is muscle contraction.  Passive contraction of muscle tissue or connective tissue produces a similar effect.  SMRT is not manual lymphatic drainage, we do not use MLD moves to stimulate the lymphatic system, but the effect SMRT has on the lymphatic system is comparable to the effect MLD has on the lymphatic system.  In traditional deep tissue, superficial lymph vessels are momentarily squashed and lymphatic flow is temporarily impinged.  By using SMRT with traditional deep tissue, we are able to keep the lymphatic system flowing.
    Both the removal of muscular tenderness and the stimulation of the lymphatic system brought forth by SMRT help to enhance any other modality I may use with a client.  I combine SMRT with traditional deep tissue, energy work, MLD, craniosacral therapy, neuromuscular therapy, and myofascial release.  Patti, a therapist who has been practicing SMRT for nine years, says,  “I have taken many, many classes.  I do sports and orthopedic massage, and also myofascial release.  But I always combine these other modalities with SMRT.  It enhances everything else I do, and lets me get deep without pain.”
    While Spontaneous Muscle Release Technique enhances any modality it is used with, it can also be used alone.  A few weeks ago I saw a client who had a recent severe sprain to his right ankle.  Seeing that his ankle had swollen two or three times its normal size, I knew that any deep work was contra-indicated.
    I modified my SMRT, using the same concept, but following the trauma pattern that had been created by the sprain, and doing extremely small movements.  He had a lateral ankle sprain, meaning his foot had moved into inversion or supination too quickly.  This had torn or damaged the lateral ankle ligaments.  Earlier I said “the simplest way to describe SMRT” was passive contraction of tissues.  In this case, passive contraction of the lateral ligaments was contra-indicated.  This is because of how the injury happened.
    Another concept of SMRT is injury patterning.  We do this by following what happened to the body when it was injured, but to a much lesser degree.  In this way, we support the injury pattern the trauma has created.  This support sends specific messages to the proprioceptors in the area, which talk to the nervous system, and release the protective response created by the injury.  This allows healing and realignment.  Additionally, these small, light movements create passive contraction which stimulate the lymphatic system and move out the stagnant inflammation that is present in most sprains.  When this client was leaving, he noted that he could put weight on his right foot, and it “looked almost normal.”
    One of the nicest things about using Spontaneous Muscle Release Technique is how the client’s body responds to the technique.  When I move into an SMRT position, the client may take a deep breath and/or stop talking, and the client’s entire body seems to relax under my hands.  “It’s a weird thing,” Rhonda, an SMRT therapist for seven years, says, “The person on the table just kind of settles deeper into the table, and I can feel the tissue thank me when I do SMRT well.
    This is a testament to another benefit of SMRT.  SMRT unblocks and moves stagnant energy, creating a calming effect for the client.  “I don’t know what SMRT is or what it does.  I just know that when I leave, I feel complete.  Like someone rearranged me at a cellular level.”  Janie says.  This could be another way to define deep tissue, feeling rearranged at a cellular level.
    I teach SMRT around the country and offer training on DVD for people who cannot spend that much time in a class.  Information can be obtained on the website for my business, Full Circle, at www.efullcircle.com.