Deep-Tissue Work with Less Pain and Effort
Deep-tissue massage could be defined as a set of moves designed to guide the therapist into deeper tissues, or as a variety of strokes meant to treat a specific area of pain. Then again, deep-tissue massage could be defined as any technique that allows the therapist to contact and affect 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. But through the years of practicing, I have come to understand that deep-tissue work without purpose can wind up causing only pain.
Many times, when a therapist finds an area of adhesion or tension, she tries whatever modality she is trained in. If the adhesion or tension does not dissolve with the techniques the therapist uses, the fallback is deep-tissue work—but not deep-tissue work with a purpose, simply deep-tissue work because the therapist does 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 without causing pain, in a way that will resolve the issue in the area and have long-lasting effects? There is an answer: Spontaneous Muscle Release Technique (SMRT, pronounced “smart”).
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 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 the release of specific tissues in a given area. The simplest way to describe SMRT is it is passive contraction of tissue.
One thing I find with SMRT is I can get into the deeper tissues of the body without causing the client pain. When I find a tender area, I think about what tissues I am contacting. I move these structures into a position of passive contraction and hold for 30 seconds. This is called a SMRT release, or position. One of the ways the passive contraction of a SMRT position affects the area being worked is by increasing blood flow.
Additionally, the SMRT position will speak to the proprioceptors of the muscles being worked, telling the proprioceptors the amount of tone the structure has been holding is no longer necessary. This is done by passively contracting to within the first 10 percent 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 a 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 the massage therapist to get into the deeper tissues. “You get into the tissue on a deeper level,” said a chiropractor who is a client of mine. “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.”
Respond to pain
One of the greatest barriers for massage therapists in performing deep-tissue work is client tenderness. Some therapists try to push past that tenderness, hoping it 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 a 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.
Let’s use the example of client “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.
The reason the axillary connective tissue is so tight and restrictive in Marti’s right axilla is 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 rib cage and moving it superior and lateral, both muscles are affected and release tone. Because this SMRT release targets both muscles and increases blood flow and nervous system awareness in the 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 un-adhering the expanded lymph node directly helps the flow of lymph fluid through that lymph node.
So, why does SMRT 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 manual lymph drainage moves to stimulate the lymphatic system, but the effect SMRT has on the lymphatic system is comparable to the effect manual lymph drainage has on the lymphatic system. In traditional deep-tissue massage, superficial lymph vessels are momentarily squashed and lymphatic flow is temporarily impinged. By using SMRT with traditional deep-tissue massage, we are able to keep the lymphatic system flowing.
In combination or alone
Both the removal of muscular tenderness and the stimulation of the lymphatic system brought forth by SMRT help to enhance any other modality a massage therapist may use with a client. SMRT can be combined with traditional deep-tissue massage, energy work, manual lymph drainage, craniosacral therapy, neuromuscular therapy and myofascial release.
Patti, a massage therapist who has been practicing SMRT for nine years, says, “I have taken 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 SMRT can enhance any massage modality, 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 his ankle had swollen two or three times its normal size, I knew any deep work was contraindicated.
I used modified SMRT and followed the trauma pattern that had been created by the sprain, doing extremely small movements. The client had a lateral ankle sprain, meaning his foot had moved into inversion, or supination, too quickly. This had torn the lateral ankle ligaments. I mentioned the simplest way to describe SMRT was passive contraction of tissues; however, in this case, passive contraction of the lateral ligaments was contraindicated due to how the injury happened.
Another concept of SMRT is injury patterning. This is done by following what happened to the body when it was injured, but to a much lesser degree. This allows us to support the injury pattern the trauma has created. This support sends specific messages to the proprioceptors in the area, which communicate with the nervous system and release the protective response created by the injury. This effects healing and realignment. Additionally, these small, light movements create passive contraction, which stimulates the lymphatic system and moves the stagnant inflammation present in most sprains. When this client left, he noted he could put weight on his right foot, and it “looked almost normal.”
One of the best things about using SMRT is how the client’s body responds to the technique. When I move into a SMRT position, the client may take a deep breath or stop talking, and his 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: It 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 when I leave, I feel complete, like someone rearranged me at a cellular level,” says “Janie,” a massage client. This could be another way to define deep-tissue work: feeling rearranged at a cellular level.
Dawn Lewis has been a massage therapist since 1995 and a massage-and-anatomy instructor since 1997. Spontaneous Muscle Release Technique (SMRT) is a modality she created in 1996 and began teaching in 1997. Through her company, Full Circle (www.efullcircle.com), she teaches SMRT throughout the U.S. and on DVD.