Permission Joseph E. Muscolino. Advanced Treatment Techniques for the Manual Therapist: Neck (2013).

Neck Deep Pressure Massage: Step by Step – Deep Stroking Massage

This blog post article is the ninth in a series of ten articles on Deep Pressure Massage of the Neck

Depth of Work

The depth of deep pressure massage should always be within the client’s range of tolerance. It is never beneficial to force deep pressure on a client or to work beyond the client’s tolerance. If this is done, the client may tighten the musculature of the neck that you are working on, either in response to the pain or in anticipation of pain. Given that one of the principle purposes of massage is to reduce muscle tone, the purpose of the deep pressure is defeated the moment the client tightens up the target muscles being worked on. Further, deep pressure should never be performed in a sudden or abrupt manner. Rather, the client should always be warmed up first with lighter and then moderate depth massage before introducing deep pressure. Even then, it is important to apply deep pressure by slowly and smoothly sinking into the client’s musculature. When the client is properly prepared and the deep work is performed appropriately, clients are often comfortable with very strong pressure.

Transitioning from Sustained Compression to Deep Stroking Massage

All of the guidelines presented thus far in this series of blog post articles for deep pressure massage to the neck are meant to perfect your body mechanics when applying sustained compression into any one spot on the client’s posterior neck. This in no way is meant to advocate sustained compression as the treatment technique of choice. It is simply easier to learn how to optimize your body mechanics by focusing on one level of the client’s neck at a time. To transition from sustained pressure in one static location to deep stroking massage in which your pressure is moved from one point to another, and maintain proper body mechanics while doing this, it is necessary to glide your treatment contact from the initial point of contact to the adjacent region of the neck. This motion should not come from moving your thumb at its joints (or your fingers at their joints). Rather, it must originate from your core by further rocking your pelvis and extending your spine forward. With stacked joints, this pelvic motion will translate into motion of your treatment contact along the client’s neck. However, it is important to keep these strokes short because the farther you reach from your initial point of contact, the more difficult it is to maintain proper body mechanics. Short deep strokes to the neck between 1 and 2 inches (2-5 centimeters) in length allow you to preserve optimal body mechanics. It is also important to note that perform a deep stroke, it is not possible to meet the contour of the client’s neck perfectly perpendicularly. Instead, we need to back off from pure perpendicular enough to allow us to slide along the client’s skin. Of course, we should back off pure perpendicular as little as possible, or we will lose force into the client’s tissues.

Treating Myofascial Trigger Points

Deep pressure massage often involves the treatment of trigger points. A trigger point (TrP) is a small focal area of tenderness that can refer pain or other symptoms to a distant site. When a TrP occurs in muscular tissue, it involves a small area of contraction that is tender and can refer; this is called a myofascial TrP, or, in lay terms, a muscle knot. Bodywork treatment for TrPs has classically been done with techniques known as ischemic compression and sustained compression. In ischemic and sustained compression, pressure is applied directly to the TrP and is held for a sustained period of time, usually 10 seconds (generally, greater pressure is applied with ischemic compression than sustained compression). However, in recent years, many authorities on TrPs (including Simons, Travell, and Simons in Myofascial Pain and Dysfunction: The Trigger Point Manual (Second Edition, see page 141) [Williams & Wilkins 1999] and Amber Davies in The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief, 3rd ed. [New Harbinger Publications, 2013]) have advocated deep stroking massage instead of sustained pressure techniques. Not only is deep stroking usually more comfortable for the client and easier on your thumbs, it seems to do a better job of increasing local arterial circulation, which is needed to truly heal a TrP. Strokes need to be only approximately an inch or two in length and are usually repeated 30 to 60 times in 1 minute. Pressure should be deep, but because the pressure is not constantly held on the TrP, it is usually better tolerated by the client. If you have not yet tried deep stroking massage for the treatment of TrPs, give this approach a try and see how your results compare with those of sustained compression techniques.

Note: Focus the Client’s Breathing for Deep Pressure Massage

When performing deep pressure massage, it can often be helpful to have the client focus on his or her breathing as the work is done. Ask the client to take in a full breath; as the client relaxes and exhales, slowly begin to sink into the client’s tissues. If very deep work is needed, this procedure may be repeated two or three times before the full depth of the pressure is reached. There is no rush and deep pressure massage work cannot be forced. It must always be within comfort and tolerance of the client. It can also be helpful to mirror the client’s breathing. In other words, as the client breathes in, you breathe in; as the client breathes out, you breathe out.

This blog post article is one of ten articles on Deep Pressure Massage Technique to the Neck.

The ten articles are:

  1. Introduction to Deep Pressure Massage Technique to the Neck
  2. Neck Deep Pressure Massage: Using Bodyweight and Muscular Effort
  3. Neck Deep Pressure Massage: Overview
  4. Neck Deep Pressure Massage: Step by Step – Positioning
  5. Neck Deep Pressure Massage: Step by Step – Contacts
  6. Neck Deep Pressure Massage: Step by Step – Use Your Core
  7. Neck Deep Pressure Massage: Step by Step – Apply Pressure Perpendiculary
  8. Neck Deep Pressure Massage: Step by Step – Engage the Tissues
  9. Neck Deep Pressure Massage: Step by Step – Deep Stroking Massage
  10. Neck Deep Pressure Massage: Prone and Side-Lying

(Click here for the blog post article: Can Massage Lessen Pain at Myofascial Trigger Points.?)