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Prenatal Deep Tissue Massage (revisited)

Revisiting this issue because it never ceases to be a problem for women trying to find massage while they are pregnant. Yesterday, I received a phone call from a woman in her third trimester whose back was throbbing and had been desperately looking for somebody to do deep tissue massage.

She asked, "Can I get deep tissue massage while pregnant? Because everybody is refusing!"

My answer was: "Yes! Of course, you can!"

Deeper pressure on the back muscles

But you may need to hunt around before you find it. A lot of spas and massage centers have a "house policy" to avoid doing any deep tissue work on pregnant women. Their policy is a safe, conservative move that has absolutely no basis in fact or science. HOWEVER, it could also be a smart move on their part -- if their therapists performing prenatal massages are minimally trained and have limited experience, perhaps it is prudent for them not to offer deeper, more involved massage that safely respects all the contraindications for pregnancy.

Here at Equilibrio, we make bold claims that pregnant women deserve and can safely receive deep tissue massage. Deep tissue work is actually indicated given the many structural changes happening to a pregnant woman’s body over a short period of time. But a pregnancy massage -- deep tissue or not -- is always going to be RESPONSIVE, SMART and RESPECTFUL of the changes happening to mom's body.

Deep pressure is responsive pressure.

We like to think that we are very, very thoughtful about how deep tissue work is done in preparation for birth and labor. But how deep is ok? Massage should not hurt. Intense is ok. But you should still be able to breathe comfortably through even deeper work.

Deep tissue should not make you jump off the table! (see funny photo)

Is that enough pressure yet?

While this image depicts a popular understanding of deep tissue massage (and, well the expectations on the part of a few clients) -- this is NOT what deep tissue massage should be doing (particularly, the MT smiling as you wince!). We do not want to create a pain response in our moms (or any of our clients). In prenatal massage, we are trying to give mom an experience in which she can gently surrender to our touch, not wince and suffer through it. We are trying to move her from a state of “doing” to “being” even in our deep tissue...sweet, gentle, surrender. We are patient with her tissue, waiting for it to release. We apply pressure to her tissue inspired by birthing women managing contractions in labor  --  surrender to her body and let it pass through, as opposed to tensing up and forcing our way through.

At Equilibrio, the bulk of our deep tissue work is slow and rhythmic. We have learned that working harder, faster and sharper elicits pain, but not results. In fact, pressure that is too intense can be counter productive -- your muscles can react and tighten up against the pressure AND you get a mild stress reaction (there goes that relaxation part to the massage).

We apply pressure slowly to a muscle to the level of that tissue's resistance and and then we wait for the muscle to release and then allow our “tool” to sink more deeply. And, sometimes the muscle doesn't release or won't release that day or for minutes. What is key here is we are trying not to “do” to the muscle, but rather allow the muscle to open, to follow the muscle’s lead. There is real subtlety here. And it’s an important shift for a woman as she prepares for birth. We are trying to help her experience manageable intensity in her muscles that she can breath through and easily surrender to. We are not aiming to conquer her muscles.

Deep tissue massage respects all the safety precautions for all prenatal massage. 

Earlier this year, a client came to me who had been on modified bed rest for preterm labor for 10 weeks already, and she was still only about 32 weeks along. Her doctor cleared her for massage, but told her not to make sure the MT avoided abdominal massage and did no deep tissue work. As MTs, we care for you, but are NOT your caregiver and we always respect you and your pregnancy by respecting any restrictions that your MD or midwife establishes (and secretly, we are thrilled they are being thoughtful about massage!!). However for this mama, after working on her neck and shoulders for a few minutes (after 10weeks of bed rest!), I was

thinking: "NO DEEP TISSUE???!!!! These muscles are screaming for deep tissue work!" We were able to get mom some relief from gentle Swedish-style massage. And then we talked with her doctor. We were able to clarify for her doctor, that not only was abdominal massage always contraindicated for a woman who was on bed rest, but that localized, slow, gentle deep tissue massage might actually be beneficial for mom. The doctor was completely on board with the idea of tension-relieving deeper work that was restricted to mom's back and neck and that mom experienced as pleasurable, and did not overwhelm mom or trigger a stress response in her body.

In pregnancy, deep tissue massage or more gentle massage, we always avoid deeper work on the abdomen and avoid abdominal massage in lots of cases anyway. We always follow strong precautions when massaging the legs so as to respect the challenged vascular tissue there and prudently follow protocol to avoid interfering with any potential blood clots (of which there is an increased risk in pregnancy), really minimizing any deeper work on those legs. We also respect mom's pregnancy by knowing and avoiding acupressure points from Chinese medicine and reflexology that either stimulate labor or are not supportive of the pregnancy. We also always position and support mom's body in a way that avoids pressure on her abdomen and uterus.

What's the conclusion here for YOU as you are trying to schedule deep tissue massage during your pregnancy? If you are experiencing a healthy pregnancy that is progressing normally, there is probably no overarching contraindication to some deeper work. However, ask yourself what feels right in your own body. And find a therapist who can speak smartly to you about any deeper work you want. What type of training do they have? How experienced are they? And ask them what limitations they would use with you. Talk to the therapist!

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