There’s rarely any justification for extremely painful massage, unless it clearly produces a better result than gentler treatment — which is rarely clear!1 It is possible that a few “brutal” deep tissue massages could do the trick where gentler treatment would fail — but there is no way to know this in advance, and massage is expensive stuff. If you’re going to gamble on a treatment, gamble on cheaper and less painful ones.

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If you are a massage therapist, or sports physical therapist, it might be a good idea to explain what a this type of massage will accomplish and what to expect.  At first, a Deep Tissue massage might feel like your typical Swedish massage. First, your therapist will warm up and prepare your muscles by applying light pressure to the areas that require attention. Only after your muscles have been sufficiently prepared will your therapist begin applying specific techniques. The most commonly used strokes in Deep Tissue massages are stripping and friction. Stripping usually involves your therapist applying deep and gliding pressure to the length of your muscle fibers with an elbow, forearm, knuckles or thumbs. Friction, on the other hand, applies pressure across the grain of the muscle in order to relieve adhesions and realign the fibers of the tissue.

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“The number one thing therapists should do to protect themselves from injury is avoid doing too much work,” says Bykofsky. She also recommends not over-scheduling, working too many hours, or holding too many deep massage sessions a week. Also, take advantage of other “tools” at your disposal, such as different parts of your hands and arms, using them for leverage to take some of the pressure off your thumbs.
There are 58 training programs accredited by the Commission for Massage Therapy Accreditation/Approval in the United States. They provide a minimum of 500 hours of massage training. Certified therapists have graduated from these programs and passed the national certification examination for therapeutic massage. They are also required to participate in continuing education programs to keep their skills current.

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Timing refers to when the massage is given: pre-event or post-event; during recovery; during a maintenance period; or when an athlete suffers an injury that requires rehabilitation. Technique refers to what application you utilize, and can include a number of different techniques: effleurage; friction; pettrisage; vibration; shaking; compression; broadening strokes; direct pressure; cross-fiber friction; range of motion; and stretching. Intent refers to your reason(s) for treatment: as warm-up; to increase blood flow; stimulate neurological pathways; aid recovery from exertion; increase flexibility; improve strength; or improve posture.
Forty-three states, the District of Columbia and five Canadian provinces currently offer some type of credential to professionals in the massage and bodywork field—usually licensure, certification or registration.[79][118] Thirty-eight states and the District of Columbia require some type of licensing for massage therapists.[119] In the US, 39 states use the National Certification Board for Therapeutic Massage and Bodywork's certification program as a basis for granting licenses either by rule or statute.[120] The National Board grants the designation Nationally Certified in Therapeutic Massage and Bodywork (NCTMB). There are two tests available and one can become certified through a portfolio process with equivalent training and experience.[121] Between 10% and 20% of towns or counties regulate the profession.[97] The National Certification offered by the NCBTMB does not mean that someone can practice massage in any state.[122] These local regulations can range from prohibition on opposite sex massage, fingerprinting and venereal checks from a doctor, to prohibition on house calls because of concern regarding sale of sexual services.[97][123]
Regain your footing with this indulgent treatment that will relax you from head to toe. The Piedmont Experience will increase blood and lymph circulation through acupressure and a rocking rhythm technique applied with warm herbal compression balls infused with herbs and spices designed to relieve the body of toxins and tension. The compression balls are then a gift to you to continue the experience at home as soak for your next bath.

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There is no consensus among reflexologists on how reflexology is supposed to work; a unifying theme is the idea that areas on the foot correspond to areas of the body, and that by manipulating these one can improve health through one's qi.[8] Reflexologists divide the body into ten equal vertical zones, five on the right and five on the left.[9] Concerns have been raised by medical professionals that treating potentially serious illnesses with reflexology, which has no proven efficacy, could delay the seeking of appropriate medical treatment.[10]


After the session, the client may experience tenderness or soreness, and the massage therapist may recommend ice or heat for easing any pain. It can also be helpful to drink water immediately following the session to flush out any toxins and rehydrate the body’s muscles. Even if the client does not experience any soreness after the massage, simple stretches can prevent any potential stiffness. It is generally recommended to avoid any strenuous activity after a massage to give the body time to recuperate.
In Mexico massage therapists, called "sobadores", combine massage using oil or lotion[102] with a form of acupuncture and faith.[103] Sobadores are used to relieve digestive system problems as well as knee and back pain.[102][103] Many of these therapists work out of the back of a truck, with just a curtain for privacy.[103] By learning additional holistic healer's skills in addition to massage, the practitioner may become a curandero.[104]
Another alarmingly common example is the sensation of skin tearing. This has been inflicted on me personally on at least three occasions, and not by poorly trained therapists — quite the opposite, the perpetrators were all well-trained massage therapists doing a kind of “fascial release” therapy that they clearly thought of as an “advanced” technique.7

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AD 1150: Evidence of massage abortion, involving the application of pressure to the pregnant abdomen, can be found in one of the bas reliefs decorating the temple of Angkor Wat in Cambodia. It depicts a demon performing such an abortion upon a woman who has been sent to the underworld. This is the oldest known visual representation of abortion.[12]

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The light-touch, free massages often offered at finish line festivals can help calm the nervous system by allowing the body to commence its natural repair state quicker, explains Rosemarie Rotenberger, an orthopedic massage therapist in Mertztown, Pennsylvania. And  Denunzio says that racers can schedule a recovery-focused sports massage within several hours up to 48 hours after an event, although she recommends massage newbies wait three to four days, as they may be too sore within the first few days fully benefit from (and appreciate) the experience.
Plantar fasciitis. According to the JAMA Network, plantar fasciitis occurs when the fibrous band on the bottom of the foot becomes irritated and inflamed, causing pain in the heel and arch areas. The Pacific College of Oriental Medicine further indicates that deep tissue massage can be an effective treatment for this particular condition as it helps “release the muscle tension, break scar tissue, and lead to its elimination.”
Reduced stress. Swedish massages are meant to maximize relaxation—you’ll be on a massage table, in a peaceful environment, with a professional spending an extended time (between 60 – 120 minutes) giving you a massage. The combination of the hands-on attention and the environment should relax you, lowering the level of the stress hormone cortisol in your body. Lowering your stress level offers a surprising number of additional benefits, including reducing or eliminating tension headaches, giving you more energy, and allowing you to get a better night’s sleep.
Mastering the application of sports massage takes years of education and experience, not to mention a love of athletics. No one modality, technique or approach works every time. It is the love of what you do, and the people you work with, that enable you to perfect your sports massage technique. I hope this information is helpful, and I hope you enjoy being a part of the massage therapy profession.
Massage of Chinese Medicine is known as An Mo (按摩, pressing and rubbing) or Qigong Massage, and is the foundation of Japan's Anma. Categories include Pu Tong An Mo (general massage), Tui Na An Mo (pushing and grasping massage), Dian Xue An Mo (cavity pressing massage), and Qi An Mo (energy massage). Tui na (推拿) focuses on pushing, stretching, and kneading muscles, and Zhi Ya (指壓) focuses on pinching and pressing at acupressure points. Technique such as friction and vibration are used as well.[70]
Pumping - The stroking movements in massage suck fluid through blood vessels and lymph vessels. By increasing the pressure in front of the stroke, a vacuum is created behind. This is especially important in tight or damaged muscle tissue as a tight muscle will squeeze blood out like a sponge, depriving the tissues of vital nutrients and energy to repair.
It’s just a theory: no one knows if this is actually effective.11 However, it may explain why so many massage patients report a “gets a bit worse before it gets much better” response to quite painful treatments: motor end plates are (painfully) destroyed by strong pressures, and then that tissue is quite sensitive and a bit weak as it heals over a day or two … and then you finally feel much better after that!

In the United Kingdom, reflexology is coordinated on a voluntary basis by the Complementary and Natural Healthcare Council (CNHC). Registrants are required to meet Standards of Proficiency outlined by Profession Specific Boards,[12] but since CNHC is voluntary anyone practicing can describe themselves as a reflexologist. When the CNHC began admitting reflexologists, a skeptic searched for, and found, 14 of them who were claiming efficacy on illnesses. Once pointed out, the CNHC had the claims retracted as it conflicted with the UK's Advertising Standards Authority code.[13]
In New Zealand, massage is unregulated. There are two levels of registration with Massage New Zealand, the professional body for massage therapists within New Zealand, although neither of these levels are government recognised. Registration at the Certified Massage Therapist level denotes competency in the practice of relaxation massage. Registration at the Remedial massage therapist denotes competency in the practice of remedial or orthopedic massage. Both levels of registration are defined by agreed minimum competencies and minimum hours.[105]
Let's look at a few examples of how timing, technique and intent work. If you need to provide a pre-event massage, and the intent is to warm-up and increase blood flow, I would use techniques such as friction, compression, shaking and stretching. If you need to provide a post-event massage, and the intent is to aid recovery from exertion, I would use effleurage, pettrisage, compression, broadening strokes and range of motion. If you are working with an injured athlete, and your intent is to assist proper formation of scar tissue, I would use effleurage, compression and cross-fiber friction, followed by ice treatment and movement.
Oils: The base oil should be a vegetable oil, cold pressed, unrefined, and free of additives. These oils contain such nutrients as vitamins and minerals in addition to fatty acids. They do not clog the pores as mineral oils often do. Essential (aromatic) oils may be added to provide additional relaxation or other therapeutic effects. Massage oil should be warmed in the therapist's hands before it is applied to the client's skin.
Posterior interosseous syndrome. Physiopedia explains that posterior interosseous syndrome is a compression of the posterior interosseous nerve, which is located near the shaft of the humerus and the elbow, that may result in paresis or paralysis of the thumbs and fingers. Though cryotherapy, ultrasound, dry needling, and other modalities often help with this condition, so too does deep tissue work that is focused on the thoracic outlet, pectoralis minor, triceps, brachioradialis, and other surrounding areas.
Some sports massage therapists use myofascial techniques that focus on stretching the fascia, which are connective tissues surrounding muscles, tendons and ligaments in the body. This particular massage technique involves the therapist applying forces in opposing directions which relaxes the tissues. It can help ease pain and increase mobility in the tissues and surrounding muscles.

A study by an author found that patients who suffered from low back pain usually show good effect in terms of their pain management when they have reflexology as the complementary treatment.25 In this study, the author used VAS scores to indicate the level of pain of the patient. The author added that this complementary treatment can be used as one of the treatment to reduce low back pain but further study on it must be conducted.23
But the relief model is certainly tempting. There are many painful-but-relieving analogies in medicine and biology.15 That’s similar to what good pain in massage feels like, but it’s not the same: no one thinks that lancing a boil or popping a shoulder joint back in is anything but painful while it’s happening.16 And we can’t necessarily take the good pain sensation at face value and assume it means there’s actually going to be a positive outcome. Brains are not all-knowing. Sometimes they see danger where there is none, and sometimes they see help where there is none.
Some strokes massage therapists use in deep tissue massage include kneading, tapping, circular movements, and elongated movements, and they may use elbows and forearms for increased pressure in addition to knuckles and fingertips. The massage therapist may ask the client to breathe through some of the slower, elongated movements, because increased oxygen can help to relax the body.
Peer-reviewed medical research has shown that the benefits of massage include pain relief, reduced trait anxiety and depression, and temporarily reduced blood pressure, heart rate, and state of anxiety.[80] Additional testing has shown an immediate increase and expedited recovery periods for muscle performance.[81] Theories behind what massage might do include enhanced skeletal muscle regrowth and remodeling,[82] blocking nociception (gate control theory),[83] activating the parasympathetic nervous system, which may stimulate the release of endorphins and serotonin, preventing fibrosis[84] or scar tissue, increasing the flow of lymph, and improving sleep.[10][85]
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.
Swedish massage is the most common and best-known type of massage in the West. If it's your first time or you don't get massage often, Swedish massage is the best place to start.  The Swedish body massage is the combination of many different  techniques rolled into one session. During this therapy session the therapist will work with the soft tissues and muscles in the body to help restore balance and health.
Finally, sports massage is designed specifically for the very physically active (whether you're a professional athlete or not). It combines Swedish, Shiatsu, and other techniques to concentrate on the areas that are related to your sport. Athletes often get sports massages to prepare for peak performance, prevent injury, and also treat injury. Sports Injury Clinic, which offers several demonstration videos, says:

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Posterior interosseous syndrome. Physiopedia explains that posterior interosseous syndrome is a compression of the posterior interosseous nerve, which is located near the shaft of the humerus and the elbow, that may result in paresis or paralysis of the thumbs and fingers. Though cryotherapy, ultrasound, dry needling, and other modalities often help with this condition, so too does deep tissue work that is focused on the thoracic outlet, pectoralis minor, triceps, brachioradialis, and other surrounding areas.

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