Research has well proven that massage can be very effective in reducing the pain that accompanies many conditions. But is massage supposed to be painful to receive? How much pain is too much pain when you are receiving deep tissue massage techniques for muscle knots and spasms? Is the saying, "No pain, no gain" true? What about post-massage soreness? Is that expected and normal?

These valid concerns are often thought, yet may be unspoken and unanswered. Let's address these important questions.

There are many types of massage, and some of them might cause a mild degree of discomfort during the treatment. No method of massage should cause significant discomfort that could be considered painful. The differences between mild discomfort and pain can be determined by implementing a pain scale that is discussed pre-massage.

The typical pain scale uses a numerical scale from one to ten; one signifying no discomfort and 10 signifying extreme pain. The middle numbers between three and six signify a therapeutic range where the sensations induced by the massage techniques could be described as "good", "effective", or "that's the spot". Whenever a sensation of "ouch" is experienced, the client needs to inform the therapist immediately so that pressure, depth and techniques can be modified. An "ouch" experience will cause the client to tense up to defend and guard against the painful feeling, which is contrary to the therapeutic intention of the massage.

Relaxation massage, given for general relaxation, relief of muscle tension and circulation enhancement is a method that does not cause discomfort. Even if deeper massage to chronic areas of tension is administered during a relaxationmassage, this should not induce "pain".

The massage techniques used to address chronic areas of tension or injuries, such as repetitive strain from occupational or sports related activities, can be mildly uncomfortable to receive. Friction massage, trigger point therapy and other techniques that are designed to break up adhesed tissue are deeper and more specific than most relaxation methods. Clear, prompt communication between client and massage therapist is very important during these deeper methods to ensure that a painful experience does not occur.

The "no pain, no gain" theory does not apply to massage. Again, if the sensation experienced during massage is considered "painful", it is likely to cause defensive guarding and is not therapeutic. Techniques should be deep enough to feel effective, but not so uncomfortable that pain results.

Post-massage discomfort can occur. Reasons for this include the amount of pressure used and the duration of the massage techniques, the health and hydration of the client's tissues, activity level of the client, and lack of post-massage care¹. The discomfort can be experienced as a mild degree of soreness, or the way you would feel after a workout, but it should not be disabling. Post-massage stretching and icing may be advised by the therapist to manage such discomfort.

To summarize, the term "pain" should not be used to describe the degree of discomfort that can accompany the deeper massage techniques used to address tight, injured, or adhesed tissues. Clear communication before, during and after the massage is essential to avoid using more pressure than the tissue can therapeutically receive as well as to avoid post-massage soreness.

Written by: Dianne Polseno, President of Cortiva Institute - Boston massage school

¹Salvo, Susan G. Massage Therapy Principles and Practice Second Edition. Saunder, MO. p. 265.