Relaxing or deep tissue massage: which to choose

When booking a massage, the question almost always comes up: “Relaxing or deep tissue?”. Many people choose by intensity (“I want a strong massage, one I can feel”) or by name. But the two have different aims, different sensations and different indications. And, in practice, a good massage often combines elements of both.

This article explains what each one is, what research says about its effects and how to choose the one best suited to what you are looking for.

Relaxing massage

Relaxing massage, often called Swedish massage, is the best known. It uses a set of classic movements:

• Long, enveloping gliding strokes along the muscles.
• Gentle kneading of the muscles.
• Light, circular frictions.
• Gentle percussion and vibration, in some techniques.

The pressure is light to moderate, the rhythm slow and regular, and it generally works the whole body or large areas.

What it is for

• Reducing stress and general tension.
• Helping you relax and, in many people, sleep better.
• Relieving mild muscle tension and tiredness.
• Providing a moment of pause and wellbeing.

What it feels like

A feeling of warmth, heaviness and relaxation, sometimes drowsiness. It should not be uncomfortable. Afterwards, most people feel calm and light.

Who it is suitable for

• Those seeking mainly relaxation and stress relief.
• Who gets it never had a massage or have low tolerance to pressure.
• More sensitive or older people, or those with more fragile skin and tissues.
• Phases of tiredness, anxiety or poor-quality sleep.

Deep tissue massage

Deep tissue massage uses some of the same movements, but with more pressure and more slowness, to reach deeper muscle layers and specific areas of tension. The therapist often uses forearms, elbows and thumbs, works area by area and may apply sustained pressure to tender points.

What it is for

• Persistent, localised muscle tension: neck, shoulders, area between the shoulder blades, lower back, thighs.
• Stiffness associated with sustained postures or repeated strain.
• Recovery after intense workouts, in those who tolerate pressure well.
• A complement to exercise and physiotherapy programmes for musculoskeletal pain.

What it feels like

Firm pressure, sometimes a “good” discomfort, intense but tolerable, especially in tense areas. It should not be a sharp, unbearable pain or one that makes you tense your body. In the following 24 to 48 hours, there may be some muscle tenderness, similar to that after a workout.

Who it is suitable for

• Those with a specific area of tension or discomfort.
• Those who play sport or have physically demanding jobs.
• Who gets it had massages before and tolerate firmer pressure well.

For whom it is not suitable (or requires care)

• People taking anticoagulants or prone to bruising.
• Marked osteoporosis.
• Recent or suspected thrombosis.
• Pregnancy (only by therapists with specific training and with adapted techniques).
• Inflamed areas, wounds, significant varicose veins, recent injuries.
• People with fibromyalgia or widespread pain, who often benefit more from gentle pressure.

Side by side: differences and how to choose

Three questions to decide

• What do I want to feel at the end? Calm and rest, relaxing. Relief of a specific area, deep tissue.
• Do I have an area that has bothered me for weeks? If so, a focused (or combined) session makes more sense. If the pain is severe, radiates or has lasted for months, also speak to a doctor or physiotherapist.
• How do I tolerate pressure? If you have never had a massage or prefer gentle touch, start with the relaxing one. The pressure can increase in later sessions.

The option many people don't know about: the combined massage

In practice, many sessions combine the two approaches: relaxing movements over the whole body, with firmer, slower work on areas of tension (for example, neck, shoulders and the area between the shoulder blades). For those who spend the day seated at a computer and arrive with tense shoulders and general tiredness, it is often the most balanced choice.

In the initial assessment, the therapist asks about your goals, areas of discomfort, health and medication, and adjusts the technique and pressure together with you.

What the evidence says

Stress and anxiety

A reference meta-analysis, with 37 controlled studies, concluded that massage reduces anxiety and tension, with more consistent effects in series of sessions than in a single session, and effects on anxiety of a size similar to some psychological interventions (Moyer and colleagues, 2004). Later reviews confirm benefits for perceived stress, mood and, in some groups, sleep quality, although many studies are small.

Low back and muscle pain

A Cochrane review concluded that massage may relieve low back pain and improve function in the short term, with low- to very-low-quality evidence and no demonstrated long-term benefit (Furlan and colleagues, 2015). In other words, it helps, but works best as a complement to exercise and movement rather than as a treatment on its own.

In a trial with 59 patients with low back pain, deep tissue massage (10 sessions) reduced pain and disability to a similar extent as the combination with anti-inflammatories (Majchrzycki and colleagues, 2014). It is a small study with no untreated control group, so it should be read with caution.

Recovery after exercise

Meta-analyses show that massage after intense exercise reduces delayed-onset muscle soreness (the “next-day aches”) and the feeling of fatigue, with small or no effects on performance itself (Guo and colleagues, 2017; Davis and colleagues, 2020). A laboratory study suggested that massage reduces some inflammatory signs in the muscle after exertion (Crane and colleagues, 2012).

Common myths

“If it doesn't hurt, it doesn't work”

False. There is no evidence that more pain brings more benefit. On the contrary: excessive pressure makes the body defend itself by tensing the muscles, and increases the risk of bruising and of pain in the following days. The right pressure is the one that lets you breathe and relax, even when it is firm. On a scale of 0 to 10, most therapists work below 6 or 7.

“Massage eliminates toxins”

There is no evidence that massage “releases” or eliminates toxins. The liver and kidneys take care of that. Drinking water afterwards is reasonable, but not for that reason.

“Massage removes lactic acid”

Nor does it. Lactate disappears from the blood naturally shortly after exertion and is not the cause of next-day aches. One study even showed that massage does not speed up its removal and may reduce muscle blood flow after exercise, compared with active recovery (Wiltshire and colleagues, 2010). The relief you feel is real, but has other explanations, mainly neurological and relaxation-related.

“Knots disappear in one session”

Tense, tender areas (“knots”) improve with massage, but tend to come back if the cause (posture, stress, lack of movement) persists. Breaks, exercise and ergonomics are part of the solution.

Safety, precautions and contraindications

Massage carried out by qualified professionals is very safe. Severe adverse effects are rare and are associated mainly with very vigorous techniques or with people who have unidentified health problems (Ernst, 2003; Yin and colleagues, 2014). That is why the initial assessment is important.

Always tell the therapist if:

• You take anticoagulants, antiplatelet drugs or have clotting problems.
• You are pregnant.
• You have osteoporosis, herniated discs, prostheses or recent surgery.
• You have significant varicose veins, heart disease, cancer or are under cancer treatment.
• You have skin diseases, wounds or infections.

Do not have a massage (and see a doctor) if you have:

• A swollen, warm, red or painful leg, especially on one side only (possible thrombosis).
• Fever or acute infection.
• A recent injury with swelling, a large bruise or suspected fracture.

After a deep tissue massage, some tenderness for a day or two is normal. Stay hydrated, move gently and avoid very intense workouts on the same area that day. Severe pain, extensive bruising or numbness are not normal: tell the therapist.

Seek urgent help (112) for chest pain, sudden shortness of breath, weakness or loss of sensation in an arm or leg. If in doubt, call SNS 24 (808 24 24 24).

At Luxmed Clinic

At Luxmed Clinic, in Algés, every massage is carried out by a massage therapist and begins with a conversation about your goals, areas of tension and health. From there, the technique and pressure are adjusted to you, relaxing, focused or combined, and you can ask for more or less pressure at any time.

Massage is a wellbeing complement and does not replace medical assessment or treatment. Results vary from person to person.

Frequently asked questions