the real health benefits of deep tissue massage from a physio expert

What is deep tissue massage?

Deep tissue massage is a therapeutic technique that applies sustained pressure using slow, deliberate strokes to reach the deeper layers of muscle and fascia (the connective tissue surrounding muscles). Unlike lighter massage styles designed primarily for relaxation, deep tissue work is specifically intended to break down adhesions—bands of rigid, painful tissue that can disrupt circulation, cause pain, limit movement, and create inflammation.

The goal is to physically break down the adhesions that cause pain and restore normal movement. When muscles are chronically tense or damaged, they can form these adhesions—areas where muscle fibres have become stuck together. Deep tissue massage works to separate these fibres, improve blood flow to the area, and reduce the inflammation that contributes to ongoing discomfort.

Evidence-based benefits of deep tissue massage

Research increasingly supports the therapeutic value of massage therapy for various painful conditions. A comprehensive 2024 systematic review published in JAMA Network Open analysed 129 systematic reviews and found moderate-certainty evidence supporting massage therapy for seven health conditions, including chronic low back pain, fibromyalgia, and myofascial pain.

Chronic pain relief

For those living with persistent pain, deep tissue massage offers meaningful relief. The JAMA Network Open review found that massage therapy demonstrated beneficial associations with pain reduction across multiple chronic conditions. Importantly, the review also noted that adverse events from massage therapy are rare, making it a low-risk option for pain management.

This matters because chronic pain requires approaches that can be sustained over time without the risks associated with long-term medication use. Deep tissue massage, particularly when integrated into a broader physiotherapy programme, offers exactly that—effective relief with minimal risk.

Lower back pain

Back pain affects most adults at some point, and it's one of the conditions with the strongest evidence base for massage therapy. NICE guideline NG59 specifically recommends manual therapy (including soft tissue techniques such as massage) for managing low back pain, but emphasises it should be part of a treatment package that includes exercise.

This is precisely why receiving deep tissue massage from a Chartered Physiotherapist makes sense—they can provide both the hands-on treatment and the exercise prescription needed for lasting results. Understanding the conditions we treat helps illustrate how massage fits into comprehensive care.

Muscle tension and trigger points

Myofascial pain syndrome—characterised by sensitive trigger points in muscles that cause pain both locally and in seemingly unrelated areas—responds particularly well to deep tissue techniques. Research published in Somatosensory & Motor Research found that deep tissue massage produced significant improvements in pain scores, disability, range of motion, and quality of life for those with myofascial pain syndrome.

These trigger points—often called 'knots'—develop when muscle fibres become stuck in a contracted state. Deep tissue massage works to release these contracted areas, restoring normal muscle function and relieving both local and referred pain patterns.

Athletic performance and recovery

Athletes and active individuals face unique physical demands that make recovery crucial. A 2025 study published in the International Journal of Therapeutic Massage & Bodywork examined 150 athletes receiving bi-weekly deep tissue massage over eight weeks. The results were striking: 89% demonstrated improved lumbar strength, whilst 96% showed improved flexibility. The study also found that bi-weekly sessions produced statistically better recovery outcomes compared to less frequent treatment.

For those training regularly—whether for competitive sport, weekend football, or general fitness—deep tissue massage can accelerate recovery between sessions and help maintain the flexibility needed to perform at your best. Our guide to avoiding sports injuries explores how treatment fits into an overall prevention strategy.

Improved flexibility and range of motion

Tight muscles restrict movement—it's as simple as that. By releasing chronic tension and breaking down adhesions, deep tissue massage can meaningfully improve how freely your joints move. This matters not just for athletes, but for anyone whose daily activities are limited by stiffness and restricted movement.

The 2024 Cochrane review on massage for neck pain found medium-to-high dose massage provided short-term improvements in both pain and function. When tight muscles around your neck or shoulders are released, you'll often notice you can turn your head more freely, reach overhead more easily, and perform everyday tasks with less restriction.

Scar tissue breakdown

Following injury or surgery, the body forms scar tissue as part of the healing process. Whilst necessary, this tissue is often less flexible than the original muscle fibres and can create ongoing restrictions. Deep tissue massage techniques can help remodel this scar tissue, improving its alignment and flexibility whilst promoting better circulation to the area.

Deep tissue vs sports massage vs Swedish massage

Understanding the differences between massage types helps you choose the right treatment for your needs. Here's how they compare:

Your physiotherapist may combine elements from different massage styles within a single session, adapting techniques to address your specific needs. For example, they might begin with lighter Swedish-style strokes to warm the tissues before progressing to deeper work on problem areas.

What to expect during your session

Understanding what happens during treatment helps you feel prepared and get the most from your session.

Initial assessment

Your first appointment begins with a comprehensive assessment—this is where seeing a physiotherapist differs significantly from visiting a spa. Your physiotherapist will take a detailed history, asking about your symptoms, how they started, what makes them better or worse, and how they affect your daily life. They'll perform physical tests to identify the source of your pain and determine whether deep tissue massage is appropriate.

This diagnostic capability is crucial. Whilst muscle tension might be causing your symptoms, there may be underlying factors—such as joint dysfunction, postural problems, or movement patterns—that need addressing for lasting improvement. A physiotherapist can identify these contributing factors and develop a treatment plan that addresses the whole picture.

During treatment

You'll be positioned comfortably on a treatment couch, with towels to maintain your privacy. Your physiotherapist will use oil or lotion to reduce friction and allow smooth movement across the skin. Treatment typically focuses on specific problem areas rather than a full-body approach.

Communication throughout is essential. Your physiotherapist will check in regularly to ensure the pressure feels appropriate—firm enough to be effective, but not so intense it causes you to tense up. Speaking up if something is uncomfortable allows them to adjust their technique for better results.

Session duration

Initial appointments at CK Physio last up to 45 minutes, allowing time for thorough assessment and treatment. Follow-up sessions are typically 30 minutes. The actual hands-on treatment time will vary depending on what's being addressed—some sessions may focus intensively on one stubborn area, whilst others might address several regions with moderate work.

After your session

Many people feel immediate relief, though it's common to experience some tiredness or mild soreness in treated areas for 24-48 hours. Drinking plenty of water helps flush metabolic waste released during treatment. Your physiotherapist will likely give you specific exercises or stretches to perform between sessions—these are important for maintaining the benefits of treatment.

Does deep tissue massage hurt?

This is perhaps the most common question people ask before their first deep tissue session. The honest answer is that you'll likely experience some discomfort, but it should be the kind that feels therapeutic rather than harmful.

There's an important distinction between pain and therapeutic pressure. When your physiotherapist works on a tight area, you may feel intensity as the tissue releases—many describe this as a 'good hurt' or 'hurts so good' sensation. This is different from sharp, acute pain, which would indicate the pressure is too much.

The 2024 Cochrane review on massage for neck pain specifically noted that side effects were limited to treatment soreness, with no serious harms documented. This aligns with what we see in practice: deep tissue massage should feel like meaningful work is being done, but never like something is being damaged.

Post-treatment soreness is normal and typically resolves within 24-48 hours. This is similar to the muscle soreness you might feel after a challenging workout—the tissues are responding to the therapeutic stimulus. If soreness persists beyond 48 hours or is severe, contact your physiotherapist.

Who should avoid deep tissue massage

Whilst deep tissue massage is safe for most people, certain conditions require caution or make treatment inadvisable. This is another reason why seeing a qualified physiotherapist matters—they're trained to identify when massage isn't appropriate and can offer alternative treatments.

Absolute contraindications

Deep tissue massage should not be performed if you have:

• Deep vein thrombosis (DVT) or blood clots
• Open wounds, burns, or active skin infections in the treatment area
• Recent surgery near the treatment site
• Unstable fractures
• Uncontrolled high blood pressure
• Active cancer with metastasis to bones
• Severe osteoporosis

Conditions requiring caution

Treatment may be possible with modifications if you:

• Are in the first trimester of pregnancy (or later pregnancy in certain positions)
• Take blood-thinning medications
• Are currently undergoing chemotherapy
• Have active psoriasis, eczema, or other skin conditions
• Have recently injured the area (acute injury)
• Are elderly with fragile tissues

If you have any health conditions, medications, or concerns, always discuss these with your physiotherapist before treatment. They can advise whether deep tissue massage is appropriate or suggest alternative approaches. For stubborn or complex conditions, shockwave therapy may offer an alternative when massage isn't suitable.

How often should you get deep tissue massage?

The frequency of treatment depends on your goals and the nature of your condition. NICE guidelines suggest up to 9 sessions over 12 weeks for back pain—roughly weekly or bi-weekly treatment initially, then tapering as improvement occurs.

For chronic pain conditions

Weekly sessions initially allow your physiotherapist to work progressively deeper as tissues begin to release. As pain reduces and function improves, sessions can be spaced further apart—typically moving to fortnightly, then monthly maintenance. The 2025 athletes study found that bi-weekly sessions produced statistically better outcomes than less frequent treatment, suggesting consistent, regular treatment outperforms sporadic sessions.

For athletes and active individuals

Treatment frequency often aligns with training cycles. During heavy training periods or competition preparation, weekly sessions may be beneficial. During recovery phases, less frequent treatment may suffice. Many athletes incorporate monthly sessions year-round as part of injury prevention strategy.

For general maintenance

Once acute issues are resolved, monthly sessions can help prevent recurrence—particularly for those whose work or activities create ongoing physical stress. Desk workers with chronic neck and shoulder tension, for example, often find regular maintenance sessions prevent minor tension from developing into significant problems.

Why choose a physiotherapist for deep tissue massage?

You can receive deep tissue massage from various providers—spas, massage therapists, sports massage practitioners. So why choose a Chartered Physiotherapist? The advantages are significant.

Diagnostic expertise

Chartered Physiotherapists complete a minimum of a degree-level qualification that includes extensive training in anatomy, physiology, pathology, and clinical reasoning. They can assess your condition, identify the underlying cause of your symptoms, and determine whether massage is the most appropriate treatment—or whether you need something else entirely.

This matters because not all pain responds to massage. A physiotherapist can distinguish between muscle-related pain that will benefit from soft tissue work and pain arising from joints, nerves, or other structures that require different interventions. They can also identify when symptoms might indicate something more serious that warrants medical investigation.

Integrated treatment

Remember the NICE guideline recommendation: massage should be part of a treatment package including exercise. A physiotherapist can provide both—delivering hands-on treatment to relieve immediate symptoms whilst prescribing specific exercises to address underlying weaknesses or imbalances. This integrated approach produces better long-term outcomes than massage alone.

Your physiotherapist might also incorporate other techniques such as electrotherapy, joint mobilisation, or acupuncture as part of your treatment plan—options that aren't available from massage-only practitioners.

Professional regulation

Chartered Physiotherapists are registered with the Health and Care Professions Council (HCPC), a regulatory body that sets standards for education, conduct, and continuing professional development. This registration provides legal protection of the title 'physiotherapist' and ensures accountability to professional standards. The physiotherapists at CK Physio are also members of the Chartered Society of Physiotherapy (CSP), the professional body that supports high standards in physiotherapy practice.

Insurance coverage

Treatment from a Chartered Physiotherapist is typically covered by private health insurance policies, including major providers like BUPA and AXA. This can make accessing regular treatment more affordable. CK Physio is registered with most major insurance companies—patients should contact their insurer before treatment to confirm coverage and obtain any necessary authorisation.

Frequently asked questions

Ready to experience the benefits of deep tissue massage?

Our Chartered Physiotherapists in Hanwell, Ealing are here to help you move well and feel well.

CK Physiotherapy
57 Elthorne Avenue, Hanwell, W7 2JY
Tel: 020 8566 4113

References and further reading

1. Mak S, Allen J, Begashaw M, et al. Use of Massage Therapy for Pain, 2018-2023: A Systematic Review. JAMA Network Open. 2024;7(7):e2422259. View study
2. National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management. NICE guideline [NG59]. View guideline
3. Gross AR, Lee H, Ezzo J, et al. Massage for neck pain. Cochrane Database of Systematic Reviews. 2024;2(2):CD004871. View review
4. Chartered Society of Physiotherapy (CSP). Finding a physiotherapist. Visit CSP website
5. Health and Care Professions Council (HCPC). Standards of proficiency for physiotherapists. View standards

This article is for general information only and does not constitute medical advice. If you are experiencing pain or other symptoms, please consult a qualified healthcare professional for personalised assessment and treatment recommendations.