In the US, licensure is the highest level of regulation and this restricts anyone without a license from practicing massage therapy or by calling themselves that protected title. Certification allows only those who meet certain educational criteria to use the protected title and registration only requires a listing of therapists who apply and meet an educational requirement.[123] It is important to note that a massage therapist may be certified, but not licensed. Licensing requirements vary per state, and often require additional criteria be met in addition to attending an accredited massage therapy school and passing a required state specified exam (basically the certification requirements in many states). In the US, most certifications are locally based. However, as of March 2014, some states still do not require a license or a certification.[citation needed] However, this is thought to change eventually as more regulatory bodies governing the profession of massage are established in each state. Furthermore, some states allow license reciprocity where massage therapists who relocate can relatively easily obtain a license in their new state. Not all states provide this option.[124]


For instance, I tried a new young massage therapist. He introduced a pain scale right away, and asked me to use it to define an intensity I was comfortable with — a 5 out 10, say — and then actually used that scale to check with me quite a few times throughout an hour treatment. He also responded with clear adjustments to his technique when I reported that we were under or over the target I’d set. Great work! BACK TO TEXT
Myofascial trigger points — muscle knots — are a ubiquitous muscular dysfunction, causing most of the aches, pains and stiffness in the world, and complicating virtually every other injury and disease process. A lot of massage is focused on them, directly or indirectly. Massage may be helpful because it relieves the symptoms of muscle knots, or even unties them. (No, not literally.)

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It’s important to be open with your massage therapist about the level of pressure and discomfort you wish to endure. This may be different for certain areas and throughout the massage, feel free to communicate with your massage therapist before and during the massage. Some massage therapists find pain to be counterproductive to the process and expect you to speak up if the pain is too much.

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My massage therapist has been doing massages for 30 years. He is really aggressive. I thought that I was going to die. The pain was so intense that I honestly feel that it was worse than having children. When the massage was complete, I felt relaxed. When I got home I felt exhausted, like I had been in a major accident. Truthfully I feel like crap. I ache from head to toe, what the heck is this? I feel absolutely horrible. I had a bath before bed and it did help somewhat. But this morning I still feel like hell …

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RCTs have a vital role in the assessment of efficacy in reflexology. However, they only address the effect of reflexology in which other pertinent issues are unexplored such as the mechanism of reflexology, psyche, and the experience of participants receiving reflexology. Nursing research has long used qualitative research to explore various health care phenomena. Similarly, qualitative approach can provide further understanding about the patient's perception and belief towards reflexology.4, 36 Qualitative research also assists in understanding the impact of the context and the process of reflexology intervention. A greater understanding of reflexology intervention has the potential to enhance the delivery of health care. Thus, it is argued that qualitative explorative methods combined with RCTs could potentially reveal the contributing factors of reflexology effect.

Chronic back pain. The American Academy of Pain Medicine (AAPM) reports that 100 million Americans suffer from chronic pain, with is more than those afflicted with diabetes, coronary heart disease, stroke, and cancer combined. Additionally, back pain is the most common type of pain reported, accounting for 27 percent of all chronic pain cases. It is also the leading cause of disability in Americans who are 45-years-old or younger. Research has found that deep tissue massage can potentially help ease this pain, offering these individuals a chance at a higher quality of life.


Bastian B, Jetten J, Hornsey MJ, Leknes S. The Positive Consequences of Pain: A Biopsychosocial Approach. Pers Soc Psychol Rev. 2014 Apr;18(3):256–279. PubMed #24727972. Bastian et al. write about “pain’s capacity to produce positive consequences, thereby decoupling the experience of pain from the experience of suffering” — pain’s silver linings, basically. BACK TO TEXT

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Before booking an appointment, ask questions about the therapist’s education and experience, like “What is your training?” “How many years have you been practicing?” and “Do you work frequently with runners?”, suggests Gammal. Seek referrals if possible, and ensure s/he is a licensed massage therapist. Rotenberger recommends a massage therapist specifically trained in orthopedic treatment and assessment, as s/he will know when to refer you to another healthcare professional, in the case that you’re experiencing chronic pain and discomfort not fixable via massage. You can find a reputable practitioner via www.orthomassage.net or www.NeuroMuscular-Reprogramming.com.
Now for some benefits that are not supported by research. The ability of sports massage to help the muscles get rid of lactic acid is not supported in research studies. Many researchers feel this is linked to the fact that sports massage does not increase blood flow to muscles. For example, a 2010 study found that blood flow was actually mechanically impeded by massage and that was a possible reason that lactic acid removal was impaired. A quicker recovery after sports massage is not yet supported by the research. Studies do support that active recovery (low-intensity exercise after work-out) is the best method of decreasing the amount of lactic acid that builds up after exercise and speeds recovery.

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Following injury, and especially if it’s also a very stressful time, inflammation can prevent proper blood flow from reaching damaged tissue and can cut off vital nutrients and oxygen. This can cause toxins to accumulate around damaged tissue, which only increases swelling and pain. Some studies have found that even self-administered massage can help reduce pain associated with plantar fasciitis and other injuries. (10)


Due to the harsher pressure of this technique, there are certain individuals who should seek pain relief elsewhere. Deep Tissue massages can be dangerous for clients who have blood clots, as the pressure and movements might cause the clots to be dislodged. If you have had blood clots in the past, currently have blood clots or are at risk of forming blood clots, you should consult a doctor before pursuing a Deep Tissue massage. If you are currently recovering from recent surgery, chemotherapy, radiation or are suffering from osteoporosis you too should speak with a doctor before experimenting with Deep Tissue massages. As this is particularly high-pressure massage, you should not allow rashes, wounds, tumors, hernias, etc. to be massaged directly. Expecting mothers should also avoid Deep Tissue massages; instead, ask your doctor about therapists that specialize in pregnancy massage techniques.
As for the commonly held belief that extra liquids are needed post-massage: that’s a myth, explains Gammal. “Massage does not release or flush out any toxins from the body, which means it won’t dehydrate you. Massage helps with recovery from lactic acid but doesn’t get rid of lactic acid.” Post-massage, you can just resume your normal hydration habits.

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The relaxation induced during the massage might feel like the endpoint, but massage care continues after leaving. First off, rest your body. Though you may feel relaxed and calm, it is important to remember the muscles have been intensely manipulated and worked on, thus needing time to recover. Try to schedule the massage appointment when other obligations and responsibilities will not follow. Continue care by drinking water and grabbing a bite to eat. Lightheadedness may occur and water and food can counteract dehydration and low blood sugars.
Trigger points or stress points may also cause muscle soreness and decreased flexibility. These points are specific spots in muscle and tendons which cause pain when pressed, and which may radiate pain to a larger area. They are not bruises, but are thought by some to be small areas of spasm. Trigger points may be caused by sudden trauma (like falling or being hit), or may develop over time from the stress and strain of heavy physical exertion or from repeated use of a particular muscle.

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In short, yes. An athlete’s medical condition and history should not be discussed with anyone except other trainers or coaches. There is nothing the media likes more than to hear a high profile athlete is sick or injured, so those discussions don’t happen outside of closed doors. The athlete is the only person who should be deciding what information they want to share.

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“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).

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Inflammation caused by chronic stress and muscle tension can lead to worsened overall health, longer recovery time, reduced immune function and cardiovascular problems, such as high blood pressure. Studies have found that massage therapy can help lower cortisol levels and even boost production of the hormone called oxytocin, which relaxes the body and has soothing effects. (7) Oxytocin is the primary hormone responsible for sustaining social bonds in humans and increasing motivation for cooperative behaviors, which is why it’s often called the “cuddle hormone” and known to be released during hugs, birth, social bonding and from touch.
You will experience some pain during the massage as this form of massage concentrates on relieving strain and tension from tissues that go deeper. The pain could also be because the massage uses movements against the muscles rather than moving with them. But if you think you’re experiencing intense pain, immediately inform your therapist. The best way to make the most of a deep tissue massage is to be as relaxed as you can and trust your therapist to massage your pain away. That’s why it’s important to go to a certified and experienced massage therapist for a deep tissue massage.

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“I decided to go into sports massage when I experienced its effects on me as an athlete,” says McElroy. “Despite having no experience as a competitive runner in high school or college, I joined a team and realized I was pretty good. I trained while working full-time and ran my first marathon, missing the Olympic trial qualifying time by 21 seconds.

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No one really knows how a painful massage can also feel so good at the same time. This is a sensory phenomenon mostly beyond the reach of science — not entirely14 — all we can do is speculate. A main question is whether good pain is good because we expect relief to follow pain, or because positive and negative qualities are being produced simultaneously. My bet is on the latter.

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