Detailed guides to painful problems, treatments & more

The massage pressure question (topic summary example)

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

I’m still churning out carefully crafted article summaries (as announced in a recent blog post), and still finding it crazy challenging and satisfying. It’s like taking a crash course in my own content. With each one, I feel more certain that these mini articles-within-articles are genuinely a great service to readers and to me: writing them forces me to refine my overall comprehension of a topic.

Today’s example is the topic summary for massage pressure intensity, a surprisingly large one (I think it’s one of the longest “summaries” I’ve written so far). Of course, there’s lot more detail (and citations) in the full article — that’s the whole point, of course. This is 310 words summarizing about eight thousand. 😃

There is no clear justification for painfully intense “deep tissue” massage, and it’s actually hazardous to many patients, but the pressure question is greatly complicated by the fascinating paradox of “good” pain, wildly varied patient pain tolerance and preferences (often timidly repressed), and popular faith in the “no pain, no gain” principle.

“Good pain” is at the heart of the pressure question: a strange, potent sensory paradox that many people actually seek out as the goal of therapy, consciously or unconciously. Either it isn’t literally painful (just intense), or it’s painful but desired anyway because of relief or belief: an actual biological relief or at least the belief that there is one. But it’s important to note that not all satisfying, relieving sensations are genuinely helpful (e.g. scratching a mosquito bite).

“Bad pain” is unpleasant but manageable and probably safe — tolerate it cautiously, to a point.

“Ugly pain” is dangerous both physically and neurologically, causing a “fight or flight” reaction — always avoid it.

People do have clear pressure preferences: they often fire massage therapists who give treatments that are too painful or too fluffy. Pressure that’s fine for you may cause severe pain, emotional distress, “sensory injury” (sensitization) in others, or even physical injury, so pressure should be customized but often isn’t. Brutal massages might be appreciated or even helpful, but most people can’t tell the difference between the kind of pain that might be a necessary part of therapy, and ugly pain that is just abusive and dangerous.

Some possible justifications for painfully intense massage (these aren’t endorsements) include the destruction of motor end plates to “de-activate” trigger points; somatoemotional release (pain often strongly “resonates” with strong emotions like grief); moving tissue fluids; or just creating a strong, novel sensory experiences (which may have many subtle benefits).

You can read the whole thing here: The Pressure Question in Massage Therapy: What’s the right amount of pressure to apply to muscles in massage therapy and self-massage?