Massage: Understanding Good vs. Bad Pain and When to Speak Up

Is a massage good if it hurts?

While some discomfort can be a sign of effective deep tissue work addressing muscle adhesions and trigger points, sharp, unbearable, or radiating pain is a red flag and indicates potential harm or nerve involvement.

Understanding Massage Pain: The Nuance

The perception of pain during a massage is a complex issue, often misunderstood. Many believe that "no pain, no gain" applies universally, but in the context of massage, this adage requires significant nuance. Therapeutic massage aims to alleviate tension, improve circulation, release fascial restrictions, and enhance muscle function. Achieving these goals may sometimes involve sensations that border on discomfort, particularly when addressing chronic issues or deeply held tension. However, there's a critical distinction between a beneficial, therapeutic discomfort and a harmful, counterproductive pain.

"Good Pain" vs. "Bad Pain" During Massage

Understanding the difference between these two types of sensations is paramount for both the client and the therapist.

Good Pain (Therapeutic Discomfort): This type of sensation is often described as:

• A deep ache or dull pressure: Typically localized to the muscle or tissue being worked.
• A feeling of release or unwinding: As if a knot or tight area is softening.
• Tolerable and manageable: You should be able to breathe through it and not feel the urge to tense up or pull away.
• Decreasing intensity: As the therapist continues to work on the spot, the discomfort should gradually lessen or transform into a more relaxed sensation.
• Associated with specific techniques: Common during deep tissue massage, trigger point therapy, or myofascial release.
• Often felt in areas of chronic tension: Such as the upper trapezius, glutes, or hip flexors.

Bad Pain (Harmful Pain): This type of sensation is a warning sign and should prompt immediate communication with your therapist to reduce pressure or change technique. It is characterized by:

• Sharp, shooting, stabbing, or stinging pain: This can indicate nerve impingement or direct nerve irritation.
• Burning sensation: Also potentially indicative of nerve involvement or excessive friction.
• Radiating pain: Pain that travels down a limb (e.g., sciatica down the leg, numbness/tingling down the arm) suggests nerve compression or irritation.
• Numbness or tingling: A clear sign of nerve compromise.
• Unbearable or excruciating pain: If the pain causes you to gasp, tense your body, or hold your breath, it's too much.
• Joint pain: Pain directly in a joint (e.g., knee, shoulder, hip) rather than the surrounding musculature.
• Bone pain: Sharp or deep pain localized to a bone.
• Pain that persists or worsens: If the pain doesn't subside or intensifies significantly, it's problematic.

When Pain Is Acceptable and Potentially Beneficial

Certain massage techniques are designed to elicit a degree of therapeutic discomfort to achieve their goals:

• Trigger Point Release: Trigger points are hyper-irritable spots within a taut band of muscle. Applying sustained pressure to these points can be intense, often reproducing referred pain patterns, but the goal is to "release" the point, leading to local and referred pain relief.
• Deep Tissue Massage: This technique targets deeper layers of muscle and connective tissue. It's used to break down adhesions, scar tissue, and chronic muscle knots. The pressure required can lead to a deep ache as these restrictions are addressed.
• Myofascial Release: This involves applying sustained pressure and stretch to the fascia, the connective tissue that surrounds muscles, bones, and organs. Fascial restrictions can be very dense and rigid, and their release can feel like a pulling or burning sensation that is deep but not sharp.
• Addressing Chronic Tension: Areas that have been chronically tight or shortened for extended periods may require more intense work to encourage lengthening and relaxation, leading to initial discomfort that gives way to relief.

When Pain Is a Warning Sign: Red Flags

It is crucial to recognize when pain during a massage indicates potential harm. Always alert your therapist immediately if you experience:

• Sharp, shooting, or electrical pain: These are classic signs of nerve irritation or compression.
• Numbness, tingling, or weakness: Also indicative of nerve compromise.
• Pain directly in a joint: This suggests issues with ligaments, tendons, or the joint capsule itself, which should be approached with extreme caution or avoided.
• Pain in a bone: Could indicate a fracture, bone bruise, or underlying skeletal condition.
• Pain that feels superficial and "skin deep" or causes bruising: This could mean too much direct pressure on superficial nerves or capillaries.
• Pain that causes involuntary muscle guarding or tensing: The body's natural protective response, which counteracts the therapeutic goals of massage.
• Pain that continues to worsen after the massage: While some post-massage soreness is normal, increasing or sharp pain is not.

The Physiology Behind Massage Discomfort

Understanding why certain types of discomfort occur can demystify the experience:

• Ischemic Compression: When pressure is applied to a tight muscle or trigger point, it temporarily reduces blood flow (ischemia). Upon release, there's a rush of fresh, oxygenated blood, which helps clear metabolic waste products. The initial ischemic phase can be uncomfortable.
• Mechanical Stretch and Release: Massage techniques physically lengthen shortened muscle fibers and connective tissue. This mechanical stretch can activate mechanoreceptors and nociceptors (pain receptors) in the tissue, leading to sensations of pressure and ache.
• Neurological Reset: Deep pressure can sometimes override the chronic pain signals being sent by the nervous system, essentially "resetting" the local pain perception. While initially uncomfortable, this can lead to a reduction in overall tension and pain.
• Inflammatory Response (Mild): Intense massage can cause a very mild, localized inflammatory response, similar to what happens after exercise. This is part of the body's natural healing process but can contribute to temporary soreness.

Communicating with Your Massage Therapist

Open and honest communication is the cornerstone of a safe and effective massage.

• Be Specific: Instead of just saying "it hurts," describe the sensation. Is it a "dull ache," "sharp pain," "burning," or "tingling"? This helps your therapist understand the underlying cause.
• Use a Pain Scale: Many therapists will ask you to rate your discomfort on a scale of 1 to 10. Aim for a 5-7 range for therapeutic discomfort. Anything above 7, or any "bad pain" sensation, should prompt a reduction in pressure.
• Don't Be Afraid to Speak Up: Your therapist wants to provide beneficial work. They rely on your feedback to adjust their technique and pressure. It's not a sign of weakness to ask for less pressure; it's a sign of self-awareness and good communication.
• Report Past Injuries or Conditions: Always inform your therapist about any injuries, medical conditions, or medications before the session, as these can influence how your body responds to pressure.

Post-Massage Soreness: What to Expect

It's common to experience some muscle soreness for 24-48 hours after a deep or intense massage, especially if you had significant tension or trigger points addressed. This "good" soreness is similar to the delayed onset muscle soreness (DOMS) you might feel after a challenging workout.

• Characteristics of Normal Post-Massage Soreness: It should be a dull, diffuse ache, not sharp or debilitating. The muscles should feel more relaxed and pliable, despite the soreness.
• Management: Staying hydrated, gentle stretching, and light movement can help alleviate post-massage soreness. Applying heat or cold packs can also be beneficial.
• When to Be Concerned: If the soreness is sharp, debilitating, or persists for more than 48-72 hours, or if you experience bruising, swelling, or nerve symptoms (numbness, tingling, weakness), contact your therapist or a healthcare professional.

Key Takeaways and Recommendations

• Not All Pain Is Bad, But Most Bad Pain Is Bad: Some therapeutic discomfort during massage can be beneficial, indicating that deep-seated tension or restrictions are being addressed.
• Distinguish Sensations: Learn to differentiate between a deep, tolerable ache (good pain) and sharp, radiating, or unbearable sensations (bad pain).
• Communicate Effectively: Always provide clear and immediate feedback to your massage therapist about the sensations you are experiencing.
• Listen to Your Body: Your body's signals are paramount. If something feels genuinely wrong, it likely is.
• Prioritize Safety and Efficacy: The ultimate goal of a massage is to promote healing, relaxation, and improved function, not to inflict unnecessary or harmful pain. A skilled therapist will work with your body, not against it.