Thank you so much for your article The Pressure Question in Massage Therapy. I just read it all. I went for a sports massage two weeks ago as I was recommended to have one as it was suggested it might help with tight calves, a side effect of some other injuries I have. I’ve been for sports massages many, many times before over the years. This one was one of the most painful experiences of my life — when I got home I was almost sick and felt in shock. My right achilles tendon was raging and it’s been bad ever since. It hurt so much when it was done (like someone was sticking knives in) and I kept asking if it was meant to hurt. I wish I’d just stopped the session or objected but I didn’t. It used to be a bad injury that affected me walking for about 6 months so I’m just devastated about this. I can hardly bear to put shoes on and its all this time on. I know there are good practitioners out there but experiences like this just make me want to stay away. I wish I’d gone to a “gentle” one.

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.


The therapist will first lubricate the skin with massage oil. Then they will perform various massage strokes and movements to warm up the muscle tissue, gradually breaking up adhesions. Techniques are applied by the hand and palms, and include circular movements, stroking, and kneading. The pressure and techniques can be customized based on your particular needs.

Pauline Wills, author of the Reflexology and Colour Therapy Workbook, teaches that colors can be applied to "areas where an abnormality has been diagnosed but which has produced no noticeable symptoms in the physical body." She states that the application can be done by imagining colors transmitted through the practitioner's hand or by Firstly, if the practitioner is sensitive to colour, they can visualize it being projected or by using "reflexology crystal torch." [8].

With no lotion or oil to cause sliding, it becomes possible to fully get a hold of the shortened fascia; this is necessary in order to lengthen it. Slow, sustained strokes are what can change this tissue from a short, hardened state to a lengthened, fluid state. The process is not unlike stretching salt water taffy. You’ve got to get a hold of it, warm it up, and work it very slowly. The work may sometimes be intense, eliciting moderate discomfort as old adhesions and chronic dysfunctional patterns are altered. But that leads to a much more fluid, easy sense in the body.

Massage therapy is also being investigated as an aide to patients with more neuromuscular disorders, such as multiple sclerosis (MS). A Iranian 2013 study published in Clinical Rehabilitation looked at 48 individuals with MS who participated in a five-week massage experiment. They were assigned to one of four groups: massage therapy, exercise therapy, combined massage-exercise therapy and control group.

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A traditional Swedish massage involves the whole body. You will begin on either your back or your stomach and flip over at the halfway point. If you have an area of particular concern, such as a tight neck, you can ask your therapist to spend more time in this area. Depending on your preferences, you can ask your massage therapist to use light, medium, or firm pressure.

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Aquatic bodywork comprises a diverse set of massage and bodywork forms performed in water. This includes land-based forms performed in water (e.g., Aquatic Craniosacral Therapy, Aquatic Myofascial Release Therapy, etc.), as well as forms specific to warm water pools (e.g., Aquatic Integration, Dolphin Dance, Healing Dance, Jahara technique, WaterDance, Watsu).[33]
Reflexologists use a map of the feet where all the organs, glands, and corresponding parts of the body are laid out. The toes reflect the head. The ridge beneath the toes on the top part of the ball of the foot is a natural shoulder or neck line. The ball of the foot reflects the chest. The arch mirrors the digestive organs, and the heel and ankles contain reflexes for the reproductive system. The inside curve of each foot (where we find the spinal reflex) corresponds to the actual curves of the spine.
I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.

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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.

Many people confuse reflexology with massage, Reiki, or acupuncture, but there are essential differences between these therapies.  Massage therapists manipulate larger areas of soft tissue in the body while reflexologists apply pressure to specific points on the feet, hands, and ears.  Unlike either massage or reflexology, Reiki does not involve any physical manipulation or pressure, but instead uses light touch to work with the subtle vibrational field thought to surround the body. Finally, while acupuncture and acupressure, like reflexology, use reflex points on the body to influence other parts of the body, the points are not the same and acupuncture uses points over the entire body.
Massage is the manipulation of soft tissues in the body. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet, or a device. The purpose of massage is generally for the treatment of body stress or pain. A person who was professionally trained to give massages was traditionally known as a masseur (male) or a masseuse (female), but those titles are outmoded, and carry some negative connotations. In the United States, the title massage therapist has been recognized as a business norm for those who have been professionally trained to give massages.
Reflexology was introduced into the United States in 1913 by William H. Fitzgerald, M.D. (1872-1942), an ear, nose, and throat specialist who called it "zone therapy." As noted in the diagram to the right, he used vertical lines to divide the body into 10 zones. Eunice D. Ingham (1899-1974) further developed reflexology in the 1930s and 1940s, concentrating on the feet [3] Mildred Carter, a former student of Ingham, subsequently promoted foot reflexology as a miraculous health method [4-6]. A 1993 mailing from her publisher stated:

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Diagnosing or treating disease would constitute the practice of medicine and would be illegal for anyone who does not have a professional license to do these things. Although many diagnose and treat disease, I am not aware of any prosecutions. In some states that license massage therapists, unlicensed reflexologists might also be prosecutable for practicing massage therapy without a license [11].
As the name suggests, deep tissue massage applies deep pressure onto specific trouble points. It feels very much like someone is torturing you on purpose by pushing into your knotted muscle, and the massage can leave you feeling sore. It's not just more pressure all over your body, however (which would be true torture), it's very specific, methodical treatment. As Moyer Wellness explains:

To understand this difference, it’s helpful to first think of the body’s fascia and muscles in layers. Notice in this image the many overlappinglayers of these tissues. Fascia is a connective tissue which permeates the entire body – literally holding the body together, wrapping around every muscle, nerve, organ, blood vessel, and bone. These wrappings are all interconnected in a three-dimensional maze. The muscle layers run superficial to deep in the body.

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Athletes tend to know their bodies fairly well, so information presented to the therapist seems to be better. Compared to the general client, the athlete is also in good shape and is concerned about getting back to the field of play as soon as possible. Some athletes have an obsessive compulsive behavior about their sport. This generally makes them very compliant with the therapists’ recommendations. 

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]
In broad terms, reflexology is intended to reduce generalized stress and help the body achieve a state of deep relaxation and homeostasis (that is, optimal balance of the body’s biochemical and other systems). Yet efficacy studies are few, and a 2009 systematic review of randomized controlled trials conducted by researchers at the Peninsula Medical School in Exeter, UK, concluded that “the best evidence available to date does not demonstrate convincingly that reflexology is an effective treatment for any medical condition.”
Thai massage works your entire body. It's one of the most invigorating types of massages, as the therapist rigorously manipulates your body, moving it into yoga-like stretches. (It's sometimes referred to as "Yoga for the lazy".) The therapist uses every part of his or her body—hands, knees, legs, and feet—to not only stretch you but also apply pressure on your muscles and loosen your joints. You might even get walked on! This type of massage is both energizing and, at times, relaxing.

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The massage types above are some of the most popular massages you can get, but there are many others. Regardless of the type of massage you opt for, be sure to tell your therapist which areas you especially need work on, whether you have any health issues, and, during the massage, how the pressure feels. When you find a therapist you like, you might want to book a standing appointment with him or her for pain and stress relief all year long.

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Deep tissue massage is best suited for people who engage in highly physical activities, such as running, or those who have an injury or chronic pain. If you have a low pain threshold or are looking for relief of tense muscles, Swedish massage is gentler and may be a better option. Speak to your doctor before trying deep tissue massage if you have an underlying medical condition.

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As the name suggests, deep tissue massage applies deep pressure onto specific trouble points. It feels very much like someone is torturing you on purpose by pushing into your knotted muscle, and the massage can leave you feeling sore. It's not just more pressure all over your body, however (which would be true torture), it's very specific, methodical treatment. As Moyer Wellness explains:

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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]

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Alhough he was a Certified Strength and Conditioning Specialist (CSCS) through the National Strength and Conditioning Association at the time, Pietrunti says that he ultimately decided to pursue licensure in massage therapy as well. This provided that missing link while also being “a good way to ‘bridge the gap’ and provide a better service to my clients,” he says.

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!
Deep tissue massage is a therapeutic technique that relieves deep-seated muscle tension and soothes chronic tightness. During a deep tissue massage, a trained therapist delivers intense pressure through slow strokes and targeted fascial release. This technique is often used to treat repetitive-stress injuries, posture problems, and sports injuries.
You may also have your own unique trouble spots, perhaps from past injuries. A massage therapist can pay special attention to these areas, monitor them for developing problems, and help keep them in good condition. An experienced massage therapist can also compliment treatment received from other health care professionals for various injuries. You may also have your own unique trouble spots, perhaps from past injuries. A massage therapist can pay special attention to these areas, monitor them for developing problems, and help keep them in good condition. An experienced massage therapist can also compliment treatment received from other health care professionals for various injuries. 

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