Is Pain During Massage Normal?

What does massage pain mean? Can it be a good thing? Should it be avoided?

*PSA: It should be noted that pain during bodywork or massage may have any unlimited number of reasons, and that any pain experienced during your session should be communicated to your therapist at the time of pain presentation.*

In the culture of massage, certain modalities are known for their somewhat–erm–vigorous–techniques. Take Deep Tissue, for example. If you didn’t make it “hurt so good,” did you even do it right? In Trigger Point release, tissue adhesions and inflammations are compressed until they…pop? Dissolve? Or otherwise deactivate. Sports massage often addresses healing injuries, and Thai massage therapists are known for twisting civilians into contortionist poses. Any of these modalities and more may cause some discomfort or even pain. Let’s dive into some common causes of pain during massage, which sensations might be beneficial or necessary, and which are best to be avoided.

First, let’s get on the same page about the terms pain vs. discomfort:

Pain is any body sensation that is unpleasant enough to cause guarding or dissociation, both of which I will explain in this article. These feelings might be shrouded in uncertainty or anxiety. This type of touch will likely not contribute to a healing environment for the body, and even has the potential to do more harm than good.

Discomfort is something that is able to be managed with concentration on the breath. It has a sense of safety surrounding it. The client knows that the sensation is temporary and purposeful and that the technique is being carried out by a practitioner that the client trusts. This type of touch may be beneficial to the massage session.

While we can’t possibly cover every scenario, let’s dive into some of the most common reasons I’ve seen clients in pain. It’s important to note that although these body conditions can cause pain on their own, massage techniques applied to these conditions may exacerbate these sensations. Much of how effective the massage is in these situations comes down to the amount of pressure or suction (when cupping) applied to the therapist's techniques as well as the therapist’s ability to guide the client through their breath and stages of release.

Common Causes of Pain During Massage

1. Muscle soreness or tightness due to frequent or overuse-I see this with athletes and with people who are very active, but they rarely stretch, roll, or otherwise soften their soft tissues between their active sessions.
2. Myofascial restriction due to chronic holding patterns-I see this with people who have been sitting in the same position or engaging in a repetitive motion for years as a part of their careers. E.g. Dental hygienists who must keep their head forward and shoulders rounded for hours at a time multiple times per week.
3. Injury-An unpleasant experience that most of us can relate to. This is a huge topic. It’s not something I specialize in, but I have a great recommendation.
4. Joint stiffness or de-stabilization-This is usually caused by inactivity and presents as either a limited range of motion or hyperflexibility.
5. Lymphatic build-up-This is another symptom of low activity levels over time and can be associated with chronic holding patterns as well as surgery interventions. Lymph build-up can also be associated with feelings of ticklishness or itchiness.
6. Anxiety or Trauma-Emotions live in the body tissues, and if the nervous system is not relaxed due to chronic stress or an old trauma, the brain may interpret even safe touch as threatening, causing the nervous system to fire pain signals.

So, Will My Massage Hurt?

I have two follow-up questions:

1. What is the goal of the session?
2. What is the state of the body?

Lots of bodies are in pain before they even get to the massage table-that’s what brought them there! Some levels of pain may be unavoidable for those who have experienced years of overuse, underuse, trauma, or neglect. In these cases, it’s best to mitigate the pain that already exists by using gentle and mindful touch. This is why I’ve chosen to specialize in nervous system massage, since many pain disorders can be addressed by way of relaxing old, engrained pain-oriented neural pathways. If your bodywork session goals go beyond relaxation, however, and you’re looking for some serious results in soft tissue rearrangement, you may be heading toward some of these more–ahem *intensive* modalities. Let’s look at what can happen when the nervous system is not taken into account prior to sessions that are likely to elicit the pain response.

The Body’s Response to Pain

Ok, let’s get back to the explanations of Guarding and Dissociation, two common responses to pain and what they mean for your bodywork sessions.

Let’s talk about Guarding. It’s probably the most common nervous system dysfunction I encounter. I call it a dysfunction because in many if not most people, they don’t know they’re doing it, and many times, they can’t control whether they’re doing it or not. So what is it? Guarding of the limbs (and nervous system) occurs when the client is not fully relaxed on the table. Even after being prompted to allow their limbs to be heavy, the client continues to “hold” or control the limb in a stiff way, rather than surrendering the weight of it to the therapist. Sometimes we call them zombie arms or rigor mortis legs. Ok, no one calls them that. But I hope that gives you a good visual.

Dissociation. This one gets a little trippy, but stay with me. Have you ever had a dream in which you were watching yourself move about like you were watching from above? Have you ever experienced this while you weren’t sleeping? I know some people who have. Dissociation is a separation of cognition or spirit from the body. This usually occurs during states of intense pain like injury, trauma, or extreme emotional distress–or maybe all of these at once. It is associated with feelings of numbness and lacking a mind-body connection.

It’s important that your therapist is educated on these bodily reactions because in these cases, the nervous system is the one that must be addressed first in order to prevent pain and execute an effective bodywork session. Addressing the nervous system will include conversation, guiding the breath, light touch, guided movement, energetic palpation, and soothing massage strokes. If the nervous system is stressed, and then intense modalities like Structural, Injury, or Sports techniques are applied, pain may occur without much long-term benefit to the client.

Myth: A painful massage is an effective massage.

Truth: In most cases, massage should be pain-free. 

Ok Ok, but what if it just FEELS better to be SQUISHED? As lovers of massage, we can all agree that compression feels great. However, when the client begins confusing pain for pleasure, it’s time to set the record straight. It’s important that we understand our body’s natural ability to feel pleasure and pain simultaneously due to the fact that both are experienced by common areas of the brain like the amygdala, orbitofrontal cortex, the nucleus accumbens, and the ventral pallidum where opioid release occurs during both pleasure and pain. Just because pain CAN feel good doesn’t mean that a painful massage will be more effective. A responsible therapist understands the morality of massage, and will always strive to do no harm.

Because the body/mind/spirit axis is complex, and because we are all unique, some pain may still occur during your sessions, even after addressing an initial nervous system relaxation and accounting for the pain/pleasure experience of having a body. Let’s talk about how you can mitigate these intense physical sensations in our aforementioned scenarios of pain during massage.

Mitigating Pain During Massage

1. Stay connected to the breath. Remember, if you can breathe through it, you’re likely experiencing discomfort rather than pain.
2. Ask your therapist to lighten up. There’s no reason to suffer in silence. A good therapist wants to know if the pressure is too much for you.
3. Ask your therapist to slow down. Slowing down technique will allow the client to connect deeper to themselves and the therapist to connect more deeply with the tissues.
4. Communicate any anxiety you’re experiencing at the time of massage. This will help your therapist gauge what type of tempo, pressure, and technique to apply.
5. Ask your therapist what you can do in between sessions to integrate the bodywork and continue moving toward less pain and more pleasure.

At 702 Bodywork, we understand the value of pain relief, and we strive to meet our clients’ session goals with customized work every session while integrating the principles that will allow the client to relax as much as possible, as our philosophy is that the body heals in a state of relaxation, not pain, which causes tissues to tense and guard. The ways that we work relaxation into our sessions are different each time, even for regular receivers. Palpating the subtle body, myofascial connection, breathwork, and Swedish techniques are some of our favorites for getting people to connect deeply with themselves, experience the pleasure of massage, engage the parasympathetic nervous system, and provide the body with the environment it needs to enter into a safe space of self-healing and homeostasis. Visit our booking page to lock in your relaxation.