No Pain, No Gain?

On occasion in my practice, I run into a client who thinks that the more pain they experience during a massage, especially during a deep tissue session, the better it is for them.  In their minds, it's "no pain, no gain" when it comes to getting all their knots and muscle soreness worked out, and I'll even have clients tell me, "Go as deep as you can.  I know it's going to be really painful, but I know that it's a good pain, so just get those knots out!"  But does a massage – even a deep tissue session – have to be extremely painful to be beneficial?  Let's examine the issue further.

First off, let's define what a deep tissue massage is.  This definition, unfortunately, is not universal for all therapists, but it is the one that I learned during my training and the one that I've found is most beneficial for the welfare of the client.  Deep tissue massage consists of slow, concentrated massage techniques that focus more pressure on problem areas with the goal being to gently force those areas to relax.  For this reason, a true deep tissue session may only cover one or two areas of the body in an hour.  The general principle behind deep tissue is that your knotty muscles can only stay knotted up for so long under pressure.  Eventually, they will have to relax because they simply don't have the strength or endurance to sustain their tension under the pressure of a hand, thumb, fist, or even elbow on top of them.  So putting pressure on a knot will eventually force that knot to release its tension because it has run out of energy and simply has to stop contracting.  Does this relaxation occur for every knot on just the first session?  Alas, no.  Some knots are much more stubborn than others and will need several sessions to be entirely worked out, especially if that is an area where you classically hold tension from your daily life.  But putting pressure on a knot will gradually cause it to release.

Now, on to the question this post is addressing.  Does one of these deep tissue sessions have to be painful to be beneficial?  The answer is both yes and no.  A certain amount of pain is to be expected, especially since many knots form right on top of or around nerve bundles, which makes working on them extra sensitive.  Even if a knot doesn't form near a nerve bundle, however, muscles still have their own nerves that tell them when something is wrong (such as a tear in the muscle fibers) and that means that a tight muscle being pressed upon is going to be sending some pain signals to the brain.  So a feeling of "it hurts so good" is acceptable during a deep tissue session.  The pain should be a "releasing" kind of pain – not unlike what you get when you stretch or gently work sore muscles – rather than an overpowering sense of pushing through something that doesn't want to budge.  What a therapist should not want to do is go so deep that extreme pain is felt, bruising is caused, or the client is crippled.  Sadly, I've heard of all of these situations occurring during over-the-top deep tissue sessions, and the people to whom it has happened have never wanted to get another deep tissue session in their lives because it was so traumatic to their bodies and their minds.

So what should both therapists and clients do during a deep tissue session (or even a heavy-pressure full-body session) to make sure that the client is not being injured?  The most important thing is communication.  If you as a client feel that the therapist is going too deep, let them know.  You know your body better than the therapist, and you should not automatically assume that the therapist knows exactly how deep to go on that knot.  After all, they can't generally can't feel what you're feeling.  The therapist should also be consistently checking in with you to make sure that the pressure is not too deep.  A great technique that I learned and will sometimes utilize for clients who have never had deep tissue before or who have only ever desired the deep-as-you-can-go variety is to tell them that, on the pain scale of 1-10, I don't want to go much over a 6, with 7 being the absolute maximum.  (Anything above that and you will be causing unnecessary pain, which will also cause the rest of the body to tense up more, and will be increasing the potential risk for injury to the client.)  Then, throughout their deep tissue session and particularly when I'm moving on to a new muscle set or am trying another technique on the current one, I will ask them to give me the number they feel from that pain scale and I will adjust my technique or the pressure accordingly.

As a brief side note, this technique is not effective for everyone.  In discussing this topic with a friend of mine at one point, she remarked, "Well, I have a very high pain threshold.  I once walked around on a broken toe for several days without realizing it was broken!  How would you do a deep tissue massage on me, since I can't feel pain until it is literally off the charts?"  What an excellent question!  In dealing with clients who tell me that they have a high pain threshold, or even a high pain tolerance, I tell them that I will do my best to listen to their bodies and that they should tell me if they think something is getting too deep, even if they can't feel any pain or think that the pain is merely somewhat intense.  That way we both decrease the potential for injury that comes when a person cannot effectively feel pain.  Really, the answer could be summed up in one word.  Teamwork.

So we've found that it's not true that a deep tissue session has to be excruciatingly painful to be effective.  In fact, the opposite is true in the long run, as the whole body will be more relaxed when less pain is felt, and a deep tissue session with great communication between therapist and client will often be the most beneficial.  If you've had a traumatic deep tissue session in the past, but still have problem areas that could really use a good deep tissue massage, consider finding a therapist that gives you a good explanation ahead of time of what to expect during the session and who actively communicates with you throughout to ensure that your overall comfort is maintained.  Remember, a good deep tissue session is made really great by the teamwork of communication between client and therapist!