Lies Massage Therapists Tell: “It has to hurt for it to work!”

This one is rarely said quite so bluntly. It’s usually delivered implicitly: “Breathe through the pain.” “This is going to hurt, but we need to work this knot out” (Don’t get me started on “knots”). “If it hurts, it needs work!”

Fine. You know what? I’ll give you that last one, straw-man massage therapist. If a muscle, joint, or tendon is tender to the touch, it could likely use some work. You know what it probably doesn’t need? Your thumbs sunk deep into its inflamed fibers, stimulating pain receptors and causing local release of pro-inflammatory chemicals. You know what the person doesn’t need? More pain in their lives.

[Source: Pierre Willemin, CC BY-ND 2.0, via flickr]

“No pain, no gain!”

“No pain, no gain.” Ugh. How tired I am of that toxic little idiom. While it has certainly been used by the timid to overcome fear, and by the sick to conquer disease, it’s usually used as justification for us to abuse ourselves and others. Think of how you’ve used it on yourself: Was it while you were training, pushing through signals that your body desperately wanted a break? Was it during a work week, where you were ignoring sleep/nutrition/family so that you could manage your workload? During school, when you were so stressed that faking a seizure started to look awfully attractive?

Life is pain. I get that. We’re borne of a painful event, childhood is frustrating and confusing, love is equal parts joy and heartache, death is often… unpleasant. No argument here. That’s why it’s all the more vital that we try to lighten this load.

We’re so hard on ourselves, and on each other. Mistakes that we make are sins, temporary foibles are catastrophes, little dramas are life-or-death situations. Is it because we’re dissatisfied with our lives and seek a tragic story arc? Have we been conditioned that feeling good is somehow wrong? Is it just the product of conventional wisdom saying that “pain is just weakness leaving the body”? Don’t get me started on that little chestnut.

Life, in its natural state, is nasty, brutish, and short. We can either perpetuate that, or, we can make a conscious decision to make things a little less shitty.

So… the topic at hand?

Sorry, I got side-tracked. That happens to me a lot.

There is such a thing as “good pain,” the kind where you stretch a sore muscle, or when a loved one rubs your aching neck, or where you can’t possibly eat one more bite of cheesecake. This is something weird and wonderful built into us, a true paradox. If it’s good, why does it hurt? If it’s bad, why does it feel better than something that just “feels good”? “Hurts so good” is a wonderful sensation, one worth pursuing and pondering, one that should make us question our body’s sanity.

I love this feeling, and, as a massage therapist, it lets me know that I’m doing something right. Maybe I’m stretching the tight lumbar fascia of a woman whose low back normally only causes her torment. Maybe I’ve discovered a neck muscle that has been the culprit in the client’s ongoing tension headaches. Maybe I’m just at that “perfect pressure” level in the feet, where any more would be painful, but any less would be boring.

As you can tell, I’m all for “hurts so good.” What irks me to no end, and what makes me go so far as to use the word “lie” in the title, is that massage therapists convince clients that unqualified pain is good.

“I know it has to hurt, so don’t hold back!”

“I only enjoy it if it hurts.” “If it doesn’t hurt, I know it won’t feel better.” These are things that clients tell me, and it upsets me every time. Whether it’s an extension of the self-flagellation instinct that we humans seem to have developed, or whether it’s an idea that past massage therapists have instilled, it’s wrong, and it makes my job harder. Now, not only do I have to work harder to satisfy the client (“can you go deeper? I can still breathe.”), I have to give sub-standard care (“man, I’m going to hurt tomorrow!”). I do my best to change clients’ minds, and I try to deliver the pressure that they want in a way that will still help, but it’s an uphill battle.

Massage doesn’t have to hurt. Unfortunately, I have no scientific studies to back me up. No one has funded a study that compares massages at different pain levels and their outcomes.

I am confident in my assertion because I have delivered painful massages (I was young) as well as sensitive massages, and both work equally well. My newer style tends to be slower, doesn’t do any “digging,” and stays well short of the point of “hurts so bad.” No one holds their breath, no one screws their eyes shut. No one walks out feeling like they just got hit by a bus. They do get their sore neck muscles stretched and squished and held, and they walk out feeling better. Just the same as if I had hurt them. What’s the difference? They don’t hate me the next day. No one gets bruises. I never get people coming back saying, “um, I think you made it worse.” Sometimes people will be sore the next day, but hopefully it’s a good kind of sore.

Have you heard of “Rolfing“? It’s a massage modality, more generally known as Structural Integration, in which deep pressure is used to cause change in tight postural and gait muscle/connective tissue. It used to be known for hurting like the devil. There’s now a new school which, while not fluffy and feel-good, has overtaken the old-school philosophy, getting the same results with much less discomfort.

Why does painful massage exist?

It makes me wonder: If the results are the same, why choose painful massage? Why do massage therapists deliver it, and sing its praises? Why do clients demand it, limp the next day, and then sing its praises? My thoughts from this point forward are mere speculation.

I think that therapists and clients alike see pain as an indicator of action. Something is happening. This isn’t like most massages, where the strokes are just fluff, and the client only feels a little better afterward. This is big. This is medicine.

Medicine tastes bad. Surgery leaves you needing a morphine drip. Injections leave you sore for days. Physical therapists stretch you until you cry. If massage feels good, how can it possible be helping you?

I think that it’s the subtle action of a good massage that leaves some therapists and clients cold. They want medicine, and they don’t care if it means causing inflammation, flu-like symptoms, or worsening of existing symptoms.

“No pain, no pain.”

Read that title again (your brain may have edited the 4th word). That’s the unofficial motto of my massage school, the Florida School of Massage in Gainesville. They do amazing work, and they’re not averse to inducing a little of the “hurts so good” kind of pain. Like I said, I’m a big fan, and there’s a big difference between the two types of pain.

How does pain-free massage work if you’re not “breaking the knot up?” First, there are no knots, and if you were to “break up” an area of muscle contracture or scar tissue, you’d be causing an injury. The body doesn’t take kindly to abrupt changes in the internal environment, and responds by releasing pro-inflammatory chemicals, increasing blood supply, and laying down scar tissue. This is why a reasonable goal for a single massage is to cause some localized increase in blood flow and nervous system stimulation, to loosen fascia, and to calm and lengthen hypertonic muscle. Unfortunately, this means that miracles are rare, and that more than one massage might be needed. Heck, some stretching might be required between sessions.

In any case, while the effects might be more subtle, they tend to be just as effective. It’s gentler, and it’s kinder. Aren’t these two things that people need a bit more of? Isn’t this something that massage could provide, along with an environment that promotes relaxation and healing?

I hope that you’ll give the subtler aspects of massage a try, whether you be massage therapist or client. What if, instead of going to the point of pain, you went just below that? What would it mean if you couldn’t accomplish everything in a single session? Does that ever happen anyway? Don’t the “knots” just come back?

Let me know your thoughts in the comments below. I’m always open to criticism. Thanks for reading, and, as always, be kind to yourself.

6 thoughts on “Lies Massage Therapists Tell: “It has to hurt for it to work!”

  1. I apologize for being a random stranger dropping in from out of the blue, but I just watched your videos that teach massage techniques for relieving TMJ pain. Regarding pain in general, I’ve always belonged to the, “If you’re not bleeding or unconscious, you’re fine. Keep going,” school of thought. I’m sure you’ll be shocked to hear that shoving my fingers into the muscle as deeply as I could has not been helpful. My next step was to take a crow bar to the side of my face (kidding, kidding. …sort of). Seriously, the thought that perhaps a slower, gentler touch would be beneficial never even crossed my mind. But! I couldn’t sleep last night so I spent a chunk of time doing exactly that, and (holy cats!) a LOT of the angry flared up pain and tension are gone. There’s still this weird feeling of pressure, but who gives a damn about that. My jaw moves! I mean, it’s actually CENTERED instead of being stuck over to the left. Madness! I didn’t think that was possible anymore. Thank goodness for kind, wise people such as yourself who are generous enough to share your knowledge with the world.

    Anyway, that video led me here, and while I’m gushing my gratitude, I have to say that your blog has been a pleasure to read. You have a really great writing voice! It’s clear and easygoing with humor in all the right places. If I were rich, I’d send you money for your expertise. However, …um, unfortunately for you, acknowledgement and appreciation are all I have to offer. Hopefully they’re a little better than nothing 🙂 Thank you again!

    1. That’s a lot better than nothing! Thank you so much for stopping by and offering kind words, I sort of needed them today. May we both benefit from continued self-directed kindness 🙂

    2. Actually Im studying to be a therapist as well and in school they had only emphasized the pain factor being 5-7 when doing trigger point therapy and Proprioceptive neuromuscular facilitation (PNF) techniques Only. Outside of those 2 modalities the classes emphasized that the more gentle you are with the body, the more likely it is to let loose and let go, as youre showing the body your intent to help rather than harm when you proceed with a slow, smooth gentle touch.

      So its not per say a lie i dont think, i think it just depends on the modality that was requested/being used.

  2. I’m a massage therapist and start every new massage client off with a spiel about “good hurt” versus “pain” and explain that I don’t like to get into the latter and it usually defeats what I’m trying to do. Many clients really relate to what I’m saying, but some give me a blank or disbelieving stare. The “no pain, no gain” philosophy is deeply ingrained in many clients’ psyches.

  3. It’s amazing to me the people that have ingrained in their mind that only through pain they can heal. I will say “knots” are an effective way of describing the way muscle fibers do bundle up sometimes though and I’ve often described it like getting the tangles out of a small chain necklace. I find providing visuals often aide in the process of healing because it makes it more interactive. That being said when deep tissue is requested of me I will clarify the type of work I’m comfortable with is more of a restorative deep tissue and requires a good amount of “warming up” an area before any structural work is done. The only way it makes sense to me that people seek out the painful massage is conditioning and addiction to endorphines released when an area is being attacked. Either way a lot of times a new outlook is just an open conversation and a good massage away. Great article! Love this message 🙂

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