Deep tissue massage is a type of massage therapy that focuses on realigning deeper layers of muscles and connective tissue (fascia). It is sometimes helpful for chronic aches and pains in contracted areas such as stiff neck and upper back, low back pain, leg muscle tightness, and sore shoulders.
It is generally accepted that deep work using only hands to apply sufficient pressure causes long term harm to the therapist hands, and that the same pressure can be applied with relative ease using the forearms and elbows.
The perception in the general public is that using hands for deep tissue work is gentler and more effective, in fact, many clients insist hands be used for deep tissue work, when confronted with this, always listen to yourself.
When asked to use hands only, attempt to ask the client "What is your motivation for this request"? to examine their reasoning and explain that you're a trained professional massage therapist who knows how to use forearms/elbows gently without causing harm.
If you aren't comfortable doing deep work with your hands because of potential damage to yourself, then you don't have to – remember that you can't work if you injure your tools of trade or wake up the next day with aching wrists and thumbs.
However, if you are comfortable and the client is too sensitive to any pain or pressure points, accept that you may never be able to use your elbows and offer a lighter treatment using only hands.
When you decide to work only with your hands, thumbs and knuckles as a last resort, using two thumbs together, keep the pressure perpendicular to the body lean your weight onto the point. Providing you apply the pressure at the right angle it's amazing how deep you can work with little effort and without hurting your thumbs. Another technique I have found works well, is pressing down onto the thumb by using the palm of hand, especially around the scapular.
I use what i feel will work the best for client’s needs. If its uncomfortable, then I try to come up with different solution. Often my clients are surprised after finding out that a forearm or elbow were used instead of hands. Most clients can't distinguish.