The reason the Pressure Question exists is that it’s hard for patients to tell the difference between nasty pain that might be a necessary part of therapy, and ugly pain that is just abusive. Not everything that hurts is therapeutic, but not every therapeutic procedure is painless! How can we tell if an intense massage technique is therapeutic or not?

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Stroking in smooth movements, kneading to loosen muscles, rubbing or friction with the practitioner using both hands back and forth in opposite directions, and striking (tapping or chopping the body with fingers or hands) are all used in combination. These movements help relax the body, increase circulation, and improve drainage in the lymphatic system.

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Sports massage has antecedents in earlier periods of history. The ancient Greeks and Romans combined massage and exercise in their athletic training. Various Asian cultures also developed forms of massage for dancers and for students of martial arts . As a formal practice, however, sports massage began in the Soviet Union and Communist bloc countries in the 1960s. Soviet teams were the first to have a massage therapist travel with them and work on their athletes on a regular and ongoing basis. Through sports and cultural exchanges, the concept of sports massage moved to Europe and the United States in the 1970s. Over time the benefits of sports massage became accepted, and sports massage became a part of the training regimen, first of professional athletes, then of college and amateur athletes. Today sports massage is recognized as a specialty by the American Massage Therapy Association.
Somatoemotional release. Mental and emotional context is a major factor in how we experience pain. Painful sensations are unusually good at stimulating catharsis — the expression of strong or repressed emotion. — because physical pain often strongly “resonates” with emotional pain.12 For instance, the pain of an injury may blur together with the emotional frustrations of functional limits and rehab. That’s a basic example, and much more complex interactions between emotional and physical pain are obviously possible. Whether it is the clear goal of therapy, or simply a natural side benefit, experiencing very strong sensations can certainly be a meaningful part of a personal growth process “just” by changing your sense of yourself, how it feels to be in your skin, and perhaps bumping you out of some other sensory rut.13

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The physiological effects are a bit of a moot point: if the pressure doesn’t suit you, you’re not likely to continue with the therapy. The exception is the patient who is willing to put up with intense pain long enough to find out if there appears to be a therapeutic effect afterwards, which there may be. But that judgement call is often made without much knowledge of whether or not the pain is really justified. BACK TO TEXT


Referred pain basically just makes trigger point stimulation feel bigger, more important. Press on a small spot … feel it down your entire arm. Wow! Impressive! Even though it’s just a thumb on a trigger point, it feels as though that “itch” is being scratched throughout an entire region. Referred pain amplifies the good pain effect — or the bad pain effect, if the pressure is too intense!
Pain relief: Relief from pain due to musculoskeletal injuries and other causes is cited as a major benefit of massage.[10] A 2015 Cochrane Review concluded that there is very little evidence that massage is an effective treatment for lower back pain.[88] A meta-analysis conducted by scientists at the University of Illinois at Urbana-Champaign failed to find a statistically significant reduction in pain immediately following treatment.[80] Weak evidence suggests that massage may improve pain in the short term for people with acute, sub-acute, and chronic lower back pain.[88]

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By stimulating reflex points on your feet, hands, face and ears, reflexology subtly impacts the whole body, affecting the organs and glands. A simple reflexology routine that works on just the feet can help you or a loved one to drift off to sleep naturally. There are nearly 15,000 nerves in your feet alone, one of many reasons that foot reflexology is so calming, soothing and effective.

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Maintenance sports massage is done at least once a week as a regular part of athletic training programs, although professional athletes who have their own massage therapists may have maintenance massage daily. Maintenance massage increases the flow of blood and nutrients to the muscles. It also keeps the tissues loose so that different layers of muscle slide easily over each other. Maintenance sports massage also helps reduce the development of scar tissue while increasing flexibility and range of motion.
Specialized massage tables and chairs are used to position recipients during massages. A typical commercial massage table has an easily cleaned, heavily padded surface, and a horseshoe-shaped head support that allows the client to breathe easily while lying face down and can be stationary or portable, while home versions are often lighter weight or designed to fold away easily. An orthopedic pillow or bolster can be used to correct body positioning.

For starters, you bear in mind the things described above that tend to cause ugly pain, and you avoid that kind of therapy like the plague. Then you look for some clues that painful pressure is okay. Here are at least three reasons why unpleasantly intense pressure might be therapeutic — “bad pain,” but not ugly. In each of these situations, it might be acceptable to tolerate sensations so intense and painful that the only thing about them that is pleasant is the part where it stops.


Six papers meet the inclusion criteria and were summarized and reviewed. Both Thai and  Swedish massages are reported to relieve chronic low back pain by enhancing physical functions;  providing pain relief, improving disability and range of motion, improving psychological functions;  reducing anxiety and improving mood. Although based on different theoretical frameworks, they appear to be equally effective in relieving chronic low back pain.
Earliest discovery of reflexology was found in Egypt based on the observation of daily life activities including the medical practices.1 Other studies have reported that reflexology emerges from China for the last 5000 years ago but there is no documentation found, so with the finding of hieroglyphic mural in the pyramid located in Saggara, reflexology is considered as a part of Egyptian culture from 2330 BC.3 At the late of 14th century, reflexology was already applied throughout the Europe with another name; zone therapy.9 Father of modern reflexology, Dr. William Fitzgerald (1872–1942) has discovered that zone therapy has been used by Aboriginal American.9 Jenny Wallace from North American Indians tribes used pressure at the feet as one of the sources of healing process.9 Fitzgerald study has brought reflexology practice to be widely used in the United States.3 The discovery of zone therapy was developed from the finding of pressure applied on many parts of body such as hands, nose, ears, and many more can relieve pain sensation.10 Dr. Joe Shelby Riley from Washington has conducted many studies of therapy including reflexology and has used this therapy for many years.9 Eunice Ingham (1879–1974) has worked together with Dr. Riley in 1930's as the therapist and work greatly to help people understand reflexology.8 She shared the technique of reflexology with others by writing many books such as “Stories the Feet Can Tell, Stories the Feet Have Told, and Stories the Feet Are Telling”.9 Reflexology has greater recognition after the emergence of another eminent woman in this therapy world with her book; “Helping Yourself with Foot Reflexology” which reached more than 500,000 copies sold.9
A couples massage allows partners to experience massage together in the same area as one therapist works on each person. Some spas turn this into a romantic event that can leave guests starry-eyed, setting the treatment in a special room or suite large enough for two, beachside underneath the stars, or in the couple’s guest room at a hotel or resort. For an extra-special touch, rooms reserved for side-by-side massage treatments may feature cozy spa fixtures such as fireplaces, shower facilities, Jacuzzis, and dual soaking tubs, and some spas offer irresistible amenities like champagne and strawberries as a sumptuous treat. Many spas offer treatments à deux so spa-goers can share a pampering experience with a significant other, but a couples massage isn’t just for romantics—mother-daughter duos and best friends may also enjoy side-by-side services. For couples, this form of massage can offer a double dose of benefits. The tandem treatment invites couples to get a bit closer and reconnect, and it can enhance intimacy and teach each partner how to take care of the other. Plus, select spas allow lovebirds to get in sync by offering sessions that teach massage techniques. Pampering and rejuvenating facials, massages, and other treatments in a half- or full-day increments can make up a whole spa package for couples. For more on Couples Massage, see our guide.

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When you think of a massage, you probably think of soothing music, a gentle brush of hands softly kneading the stress from your shoulders, maybe even of a loved one offering to rub your back after a long day at work. While some massages can be soothing, and rely on gentle touches to work out a client’s stress or anxiety, there are other massages that have a little more grit to them. For example, the Deep Tissue massage, which is very similar in style to the Swedish massage, utilizes some of the same techniques as its much gentler cousin; Deep Tissue massages, however, are designed to focus on the deeper layers of muscle tissues and fascia, the protective layer that surrounds muscles and joints. Working out these harder to reach muscles will require more pressure, making the Deep Tissue massage slightly uncomfortable, gritty and highly effective.

Manual lymphatic drainage is a technique used to gently work and stimulate the lymphatic system, to assist in reduction of localized swelling. The lymphatic system is a network of slow moving vessels in the body that carries cellular waste toward the heart, to be filtered and removed. Lymph also carries lymphocytes, and other immune system agents. Manual lymphatic drainage claims to improve waste removal and immune function.[47][48][49]

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In Japanese, shiatsu means "finger pressure." For shiatsu massage, the therapist uses varied, rhythmic pressure on certain precise points of the body. These points are called acupressure points, and they are believed to be important for the flow of the body's vital energy, called chi. Proponents say shiatsu massage can help relieve blockages at these acupressure points.

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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.
Massage used in the medical field includes decongestive therapy used for lymphedema[10] which can be used in conjunction with the treatment of breast cancer. Light massage is also used in pain management and palliative care. Carotid sinus massage is used to diagnose carotid sinus syncope and is sometimes useful for differentiating supraventricular tachycardia (SVT) from ventricular tachycardia. It, like the valsalva maneuver, is a therapy for SVT.[52] However, it is less effective than management of SVT with medications.[53]
Reflexology and acupressure are both "reflex" therapies in that they work with points on one part of the body to affect other parts of the body. While reflexology uses reflexes that are in an orderly arrangement resembling a shape of the human body on the feet, hands, and outer ears, acupressure uses over 800 reflex points that are found along long thin energy lines called meridians that run the length of the entire body.

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For me, the opportunity to work with individuals who have such an awareness of their bodies is exceptional. You and the athlete are a team. Locating an area of dysfunction, aiding in the relief or facilitating improvement in the area, then watching the athlete go out and perform well is uplifting. The environment is charged. What’s more, learning from health care professionals while teaching them how massage fits into overall health and wellness is just plain awesome! 
Accredited sports massage therapists must first complete a course in general massage from a school accredited by the American Massage Therapy Association/Commission on Massage Training Accreditation/Approval (AMTA/COMTAA) or their State Board of Education. They must then complete an additional training program approved by the AMTA National Sports Massage Certification Program. Many sports massage practitioners also complete the National Certification Examination for Therapeutic Massage and Bodywork.

According to the Neuromuscular Therapy Center, NMT is one type of deep massage technique that focuses on applying manual therapy to soft tissue with “quasi-static pressure” in order to stimulate skeletal striated muscle. (17) In addition to massaging a painful or inflamed muscle, the area around the affected muscle that normally supports it is also massaged in order to release tension. NMT therapists often focus on several factors that can add to muscle or tissue dysfunctions, including joint pathologies, postural positioning, disruptive habits of use, nutritional components, emotional well-being, allergies and neurotoxins.


The Spa at Norwich Inn, named "Best Destination Spa in New England" in the 70th Anniversary issue of YANKEE Magazine, "Best Resort in Connecticut" by New England Travel & Life, and "Best Day Spa in Connecticut" for 10 consecutive years by readers of Connecticut Magazine, and rated "Best Day Spa for 2015" by readers of Hartford Magazine. The Spa at Norwich Inn is a member of the Historic Hotels of America, a program of the National Trust for Historic Preservation.

“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).


The Swedish massage can also be used as therapy for people who suffer from any type of debilitating joint disorder that causes them pain. This benefit of the Swedish massage works to increase the elasticity in the tissues, flexibility, and to reduce the paint that they feel. After the Swedish massage many of these people will find that they are able to use their joints more than before and with little to no pain.

Reflex zone is the region in the zone therapy that illustrates its interconnection with the whole parts of the body. Pressure applied to this region will help specific organ or particular part to alleviate the pain and symptoms of a disease. According to the theory, there is an invisible pathway that runs along the body in a vertical form based on the lines instead of reflexology maps in which each point on the soles of hand and feet correspond to a specific organ. Reflex zone therapy (Fig. 9) represents five zones in both sides of the feet.12 This zone is running along the whole body parts from top of the head until the tips of the toes and fingers and the whole body is divided into ten reflex zones.12 Each zone interconnects with different parts of the body.10 Reflex zone therapy-specific organ relationship is presented in Table 1 and Table 2.

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Thai Massage is a popular massage therapy that is used for management of conditions such as musculoskeletal pain and fatigue. Thai Massage involves a number of stretching movements that improve body flexibility, joint movement and also improve blood circulation throughout the body. In one study scientists found that Thai Massage showed comparable efficacy as the painkiller ibuprofen in reduction of joint pain caused by osteoarthritis (OA) of the knee.[69]
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]
Massage is hindered from reaching the gold standard of scientific research, which includes placebo-controlled and double blind clinical trials.[86][87] Developing a "sham" manual therapy for massage would be difficult since even light touch massage could not be assumed to be completely devoid of effects on the subject.[86] It would also be difficult to find a subject that would not notice that they were getting less of a massage, and it would be impossible to blind the therapist.[86] Massage can employ randomized controlled trials, which are published in peer reviewed medical journals.[86] This type of study could increase the credibility of the profession because it displays that purported therapeutic effects are reproducible.[87]
BC 500 Jīvaka Komarabhācca, also known as Shivago Komarpaj, the founder of Traditional Thai massage (Nuad Boran) and Thai medicine.[citation needed] According to the Pāli Buddhist Canon, Jivaka was Shakyamuni Buddha's physician.[citation needed] He codified a healing system that combines acupressure, reflexology, and assisted yoga postures.[citation needed] Traditional Thai massage is generally based on a combination of Indian and Chinese traditions of medicine. Jivaka is known today as "Father Doctor" in Thailand.[citation needed]
The American Commission for Accreditation of Reflexology Education and Training (ACARET) sets the standards for education required for the reflexology profession. It also credentials those involved with educating students of reflexology. The American Reflexology Certification Board (ARCB) has a three-part examination process to ensure the practitioner has met the standards set by the board. In order to be certified through ARCB, a minimum of 110 hands-on training hours must be completed.

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Practices resembling reflexology may have existed in previous historical periods. Similar practices have been documented in the histories of China and Egypt.[9] Reflexology was introduced to the United States in 1913 by William H. Fitzgerald, M.D. (1872–1942), an ear, nose, and throat specialist, and Edwin F. Bowers. Fitzgerald claimed that applying pressure had an anesthetic effect on other areas of the body.[16][17] It was modified in the 1930s and 1940s by Eunice D. Ingham (1889–1974), a nurse and physiotherapist.[18][19] Ingham claimed that the feet and hands were especially sensitive, and mapped the entire body into "reflexes" on the feet, renaming "zone therapy" reflexology.[20] "Modern reflexologists use Ingham's methods, or similar techniques developed by the reflexologist Laura Norman."[9]
One theory is that muscle knots may be caused by something that goes wrong at the “motor end plate” — where a nerve ending attaches to a muscle cell.9 We don’t know why this happens, or what exactly goes wrong, but there is circumstantial evidence that motor end plates are the “point” in trigger point. That evidence is too complex and controversial to review properly here. It is explored in detail in my book. Some research has suggested that it may actually be possible to physically destroy the motor end plate with strong massage, thereby inactivating the trigger point.10 When it regrows — these are microscopic structures, it doesn’t take them long to heal — the trigger point may be gone.

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As for the basics of how it works, foot reflexology simply refers to the reflexes that have been mapped out in the foot. There are many different foot reflexology charts that show where the reflexes are for every part of the body. Although it is like a massage, its principles are entirely different. It is thought that reflexology works through nerve endings, while massage focuses on the muscles and soft tissue of the body. This is where the practice gets its name; it works on the reflexes, not just the skin, muscle, or tissue. It should not be painful, though like in a massage there could be stressed areas of your body that are more tender or uncomfortable. However, the applied pressure to those areas, the less tender they will become. 

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Pain management. If you have a condition like sciatica or osteoarthritis and are suffering from chronic pain as a result, Swedish massage can be an effective method for managing that pain in a natural way. Notify your massage therapist about your pain points, he or she can target those areas and use a stroking motion to improve local circulation and reduce muscle tension.
Accredited sports massage therapists must first complete a course in general massage from a school accredited by the American Massage Therapy Association/Commission on Massage Training Accreditation/Approval (AMTA/COMTAA) or their State Board of Education. They must then complete an additional training program approved by the AMTA National Sports Massage Certification Program. Many sports massage practitioners also complete the National Certification Examination for Therapeutic Massage and Bodywork.

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Swedish massage is the most common massage therapy technique in the United States. (In case you were wondering, Swedish massage is called “classic massage” in Sweden.)   A Swedish massage focuses on overall relaxation, circulation, and physical and mental wellness.  Swedish massage includes gliding, kneading, tapping, stretching, and cross-friction strokes.
Certain massage therapists have specialized training in techniques that help treat people with injuries, inflammation, tears and limitations. Although more than one massage session is usually needed to provide relief and see improvements in pain, well-trained therapists can usually recommend practices or stretches for you to try at home that can further help improve healing.

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Acupressure [from Latin acus "needle" (see acuity) + pressure (n.)[31]] is a technique similar in principle to acupuncture. It is based on the concept of life energy which flows through "meridians" in the body. In treatment, physical pressure is applied to acupuncture points with the aim of clearing blockages in those meridians. Pressure may be applied by fingers, palm, elbow, toes or with various devices.


Massage may be an appropriate technique for helping certain sports injuries, especially muscle injuries, to heal. When treating an injury, however, it is best to seek advice from a qualified sports therapist or a specialist in sports medicine before performing any massage. Certain ligament and joint injuries that need immobilization and expert attention may be aggravated by massage.

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