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October 2010

Is Massage Supposed to Hurt?

by Dianne Polseno, president of Cortiva Institute–Boston

Is Massage Supposed to Hurt?, futureLMT.comThere are many types of massage, and some might cause a mild degree of discomfort during treatment. No method of massage should cause significant discomfort that could be considered painful. You can establish communication to determine the differences between mild discomfort and pain by implementing a pain scale that is discussed pre-massage.  

The typical pain scale uses a numerical scale from 1 to 10; 1 signifying no discomfort and 10 signifying extreme pain. The middle numbers between 3 and 6 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 you immediately so that pressure, depth and technique can be modified. An “ouch” experience will cause the client to tense up, defending and guarding against the painful feeling, which is contrary to the therapeutic intention of the massage.  

Relaxation massage, given for general stress relief, decreased muscle tension and increased range of motion, is a method that does not cause discomfort. Even if deeper massage to chronic areas of tension is administered during a relaxation massage, this should not induce a sensation a client would describe as “pain.”  

It is true that the deeper massage techniques used to address chronic areas of tension or injuries, such as repetitive strain from occupational or sports-related activities, can '

be somewhat 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 you and your client is important during these deeper methods to ensure a painful experience does not occur.  

The “no pain, no gain” theory does not apply to massage. If the sensation experienced during massage is considered “painful,” it is likely to cause defensive guarding and may adversely affect the therapeutic value of your work. Techniques should be deep enough to feel effective, but not so deep and invasive that pain results.

Post-massage discomfort can occur. Reasons for this include the amount of pressure used and duration of the massage techniques, the health and hydration of the client’s tissues, activity level of the client and lack of post-massage care.  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. You can recommend post-massage stretching and icing to manage any 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 minimize or avoid post-massage soreness.

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

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