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Massage work which is performed with a very heavy, or pin-point pressure, is often termed deep tissue massage (sometimes hyphenated). Deep tissue work may incorporate effleurage, petrissage, tapotement, vibration and other, related massage techniques.

In parts of the body where muscles lie underneath other muscles, a superficial 'rubdown' may not address the actual area which needs massage. The lower leg, where the soleus lies deep to the much larger gastrocnemius (calf) muscle or the buttock, where the small (but frequently sore) piriformis is covered up by the massive gluteus maximus are two examples of places often in need of deep tissue massage. Likewise, individuals who have very well-developed muscles, or very sore/tired ones, need a great deal more pressure than regular clients and may be good candidates for deep tissue work.

In practice, deep tissue massage is very similar to other massage work, but with a few practical differences because of the amount of pressure required. Often, the massage cream or lotion used in deep tissue massage is lighter and has less slip than that which is used in gentler, Swedish massage. Many therapists start an area with no cream at all then apply massage cream after warming the muscles up.

Deep tissue effleurage is usually applied with the side or heel of the hand, the forearm or flat of the elbow. Petrissage may be performed by the therapist leaning into the client with the knuckles or heels of the hands and alternating pressure or "knuckle walking" to produce a kneading effect. On limbs, a full-hand squeeze or pressing the heels of the hands toward each other makes for very deep petrissage.

Anyone performing deep tissue massage should exercise extreme care not to work over areas where deep pressure may be dangerous or uncomfortable: the backs of the knees, kidneys, viscera, neck and armpits are among the places where deep tissue massage is not appropriate. Likewise, while deep effleurage along the muscles next to the spine (the erectors spinae) feels wonderful, the therapist should not massage directly over the vertebrae. Very thin or older clients may not be good candidates for deep work, as heavy pressure on persons who are elderly or who do not have sufficient muscle mass could cause injury.

Deep tissue massage, when performed correctly, should not cause significant pain, although it may be a bit uncomfortable for a moment on areas where the muscles are fatigued or 'knotted.' These sore areas are best worked with slow, deliberate pressure, and the person performing the massage should repeatedly ask the recipient if the pressure is appropriate. If you are in doubt about how much pressure is appropriate for a given area or person, a useful rule of thumb is this: decrease pressure and increase time.

Working deep tissues can be a serious workout for the therapist. Rather than wearing oneself out, it is best to use your own body weight and let gravity do a lot of the work where possible. Judicious use of leverage can also maximize pressure without too much work. In this fashion, an experienced massage therapist can perform several full-body deep tissue massages without ever tiring out.

Deep tissue massage is an extremely popular technique and is a good addition for therapists or anyone who wants to know how to give a really good massage. Practice, as the old saw has it, makes perfect, and the best way to learn to give deep tissue massage is to do so repeatedly. Your friends will thank you!

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