Does massage hurt?

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When you have a massage, even a sports massage should it be painful and actually hurt or not?

At Hawkes Physiotherapy we pride ourselves on being bang up to date with the latest research on everything that we do, including massage. Often many massage therapists are behind the times on this and are doing things that have always been done but are no longer considered correct and in some cases could be doing you more harm than good! We have seen people who visit our Stoke-on-Trent clinics for Sports massage who have been effectively beaten up with some of the deepest massages known to man at other clinics and this is just wrong. So from their previous experience, in answer to the question, “Does massage hurt?” their answer would be a resounding yes, but should it?

Is massage done too hard actually bad for you?

The short answer is yes! If you have a watch of the video below, which goes into a research study by Posadzki et al (2013) on massage being done too hard and how bad it can be, then you may be surprised. Amazingly, it shows that massage done too deep could actually be life-threatening in extreme cases. Another amazing study was done by Lai et al (2006), where they describe an elderly man who suffered kidney failure from rhabdomyolysis the day after a really, really deep massage session.  Don’t worry though, our sports massage is done at the correct depth for you and your problem rather than the “no pain no gain” approach!

Does massage break down scar tissue?

Many times, people are told that the massage is deep because the treatment is trying to break down scar tissue under the skin. There are some major issues with this statement. The first thing to recognise is that, how can you tell what you are feeling is scar tissue and not just a tense band of muscle (Read more about these here). The next thing, making the presumption that scar tissue is bad and needs to be broken down! When you injury a part of your body, your healing response is to replace the tissue with a scar as we are unable to produce ‘like for like’ tissue and without this scar, we would still be ‘damaged’. This means that scar tissue is normal and doing a particular job for us, so why on earth would you even be trying to break it down? Now I know there can be scar issues such as keloid scarring but this is not the type of thing that is often being touted for. Even skin scar massage evidence is weak according to this literature review by Shin et al (2012). The final thing is that could you even break down scar tissue with your hands anyway. Would you not tear and damage the skin first? The analogy that I use is, “Can you break down that brick wall but without damaging the paint or plasterwork?” The simple answer is NO! So this idea of hard sports massage being used to break down scar tissue is flawed making the rock hard, deep painful massage obsolete. The current thinking behind why these types of mechanical therapies are effective is less structural and more neurological. Basically, you are affecting the nervous system, creating pain relief, relaxation of muscle, which, in turn, causes better mobility and function. It is easy to assume that we have stretched out some fascia or that the scar has been broken down to enable the improvement but new thinking now shows that those effects are primarily driven by our nervous system’s response to the sports massage or other mechanical treatment. (Behm et al 2019).

Should you feel sore after a massage?

Again, this is a commonly held belief. People think soreness after a massage is a good sign. If you just think logically it doesn’t add up. For example, a common goal of having a deep tissue massage is to relax, recover and feel less pain. In fact, relieving things like delayed onset muscle soreness (DOMS) is something that is one of the main benefits of sports massage as shown by Weerapong et al (2005). So let’s analyse why going too deep may be bad:

Is pain relaxing?

Nope!

Do muscles relax around pain or do they tense up as a reflex?

Erm, they tense up!

There is something called the pain tension cycle, which is the reaction of muscle tone increasing in response to pain (Hunt et al 2019).

So what is the soreness that you feel after a massage?

It’s inflammation!

…but this is only if the massage is done too deep. In fact, if massage is done correctly then it reduces inflammation according to Crane et al (2012).

So why is inflammation rising in response to the massage?

Damage!

Yes, you heard me right, if your sports massage is done too deep then you cause tissue damage and the human body’s response to damage is to create inflammation to effectively heal the damage caused.

Yes, that’s correct, a massage that is too deep will cause more damage, which will increase the amount of recovery required not reduce it. It’s kind of like an overdose of massage and like anything, the optimal effect of anything is about the dose, not just the intervention.

All is not lost though!

A Sports massage that is done correctly at the right depth, that is nice and relaxing, that you feel better for during and after is exactly the right choice. This is exactly what we do with our Sports massages at our clinics in Stoke-on-Trent. Now if you want a deeper deep tissue massage then we can definitely cater to this but there is deep and then there is too DEEP!

So done correctly massage does reduce pain, tension and can speed up recovery. Here is a video looking at the research on this:

If you need any further information on sports massage at our clinics in Stoke-on-Trent or would like to book an appointment then call Hawkes Physiotherapy on 01782 771861 or 07866 195914.

DISCLAIMER:

The content in this blog article is provided for general information purposes only and is not meant to replace a physiotherapy or medical consultation.

  • Behm, David G., and Jan Wilke. “Do self-myofascial release devices release myofascia? Rolling mechanisms: A narrative review.” Sports Medicine (2019): 1-9.
  • Crane, Justin D., et al. “Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage.” Science translational medicine 4.119 (2012): 119ra13-119ra13.
  • Hemmings, Brian J. “Physiological, psychological and performance effects of massage therapy in sport: a review of the literature.” Physical Therapy in Sport 2.4 (2001): 165-170.,Poppendieck, Wigand, et al. “Massage and performance recovery: a meta-analytical review.” Sports medicine 46.2 (2016): 183-204.,Zainuddin, Zainal, et al. “Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function.” Journal of athletic training 40.3 (2005): 174.
  • Hunt, Emily R., et al. “Using Massage to Combat Fear-Avoidance and the Pain Tension Cycle.” International Journal of Athletic Therapy and Training 24.5 (2019): 198-201.
  • Lai MY, Yang SP, Chao Y, Lee PC, Lee SD. Fever with acute renal failure due to body massage-induced rhabdomyolysis. Journal of Nephrology, Dialysis and Transplantation. 2006 Jan;21(1):233–4.
  • Poppendieck, Wigand, et al. “Massage and performance recovery: a meta-analytical review.” Sports medicine 46.2 (2016): 183-204.
  • Posadzki, Paul, and Edzard Ernst. “The safety of massage therapy: an update of a systematic review.” Focus on Alternative and Complementary Therapies 18.1 (2013): 27-32.
  • Shin, Thuzar M., and Jeremy S. Bordeaux. “The role of massage in scar management: a literature review.” Dermatologic Surgery 38.3 (2012): 414-423.
  • Weerapong, Pornratshanee, Patria A. Hume, and Gregory S. Kolt. “The mechanisms of massage and effects on performance, muscle recovery and injury prevention.” Sports medicine 35.3 (2005): 235-256.
  • Zainuddin, Zainal, et al. “Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function.” Journal of athletic training 40.3 (2005): 174.

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Online Physiotherapy

Put simply this is Physio done via either telephone or video over the internet. Skype and facetime are examples of this.

Contrary to popular belief online physiotherapy can be very effective and it can help the same injuries that face to face physio can help. I have helped many people with injuries such as disc prolapses, tennis elbow, neck pain and much more).