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.
Sit comfortably in a chair with your feet on the floor, and close your eyes. Once you are settled and notice your breathing, inhale through your nose for a count of 4, hold it for a count of 7, exhale through your mouth for a count of 8, and repeat. The pace doesn't matter, it should just be something that feels good to you. The key is having the exhale really stretch out much longer than the inhaling. Try and make the exhale smooth and have almost all of the air leave your body. Do it with the counting as long as you need to get the pace down before going to the next step. For me this takes a couple minutes.
In any case, the whole notion that you want or need to get rid of lactic acid in the first place is just bogus. Lactic acid is not the cause of muscle pain at any time except the immediate aftermath of intense exercise (and probably not even then). Research has shown that muscle fatigue and the “burn” that you feel as you exercise intensely is probably caused by calcium physiology, not an accumulation of lactic acid.67 In particular, lactic acid does not cause soreness the day after exercise — yet another myth, and a particularly bad one that will just not die!68

For now, and maybe forever, we can only judge these methods on the basis of the the strength of their defining idea. What’s different about it from other common massage methods? Anything? What can it do that supposedly other techniques cannot? You’d be surprised how many barely count as more than a slight variation on Swedish massage. Even if it is distinctive, is the big idea any better than a pet theory? Most are not. The history of medicine is littered with pet theory corpses. Most treatment ideas do not work out (null hypothesis), even really good ones. And almost everything that is worthwhile about massage is probably thanks to being artfully touched, which you’ll get from most methods.
Massage-StLouis.com [Internet]. Sanvito A. How Does Massage Work?; 2016 December 31 [cited 17 Feb 28]. While the skin is indeed “the surface of the brain,” there are of course many sensory receptors in deep tissues as well. Massage therapy mainly interacts with the nervous system via the skin, which is extremely richly innervated, and the importance of this is often underestimated or discounted entirely … but it’s not limited to that. For instance, I’ve always particularly loved having my joints moved passively, which creates a flood of proprioception — movement/position sensation — that my brain didn’t initiate, which feels weird in a delicious way. BACK TO TEXT
During pregnancy, your body goes through major changes. Pregnancy massage can help with these changes by reducing stress, decreasing arm and leg swelling, and relieving muscle and joint pain. Massage may be particularly helpful during a time when medication and other medical options may be more limited. Using specially designed massage pillows, the massage therapist will help get you into a comfortable position for this type of massage.
Myofascial trigger points — so-called “muscle knots” — are increasingly recognized as a factor in many of the world’s aches and pains. This book-length tutorial focuses on advanced troubleshooting for patients who have failed to get relief from basic tactics, but it’s also ideal for starting beginners on the right foot, and for pros who want to stay current and as science-based as possible. 196 sections inspired by the famous texts of Drs. Travell & Simons, but also much more recent science. Also offered as a free bonus (2-for-1) with the low back, neck, muscle strain, or iliotibial pain tutorials. Buy it now for $19.95 or read the first few sections for free!
For instance, basic research has shown that touch is neurologically complex and probably has many physiological effects. Skin is fantastically rich in nerve endings — up to about 10,000 per square centimetre9 — and in 2009, Swedish researchers identified specialized nerve fibers that respond only to light stroking of a certain speed.10 This reinforces the obvious: massage can provide people with a rich and novel sensory experience, which could be a major mechanism for pain relief and other therapeutic benefits. If massage works, it’s mainly because of the neurology of touch (as opposed to, say, changing tissues).11
When you are looking for massage therapy, be sure to check which type of massage a practitioner can provide. Match that with the benefits you hope to get from the massage session. You may want to chat with several different practitioners to find the one who understands your needs and is used to working with people with similar goals. Be sure also to discuss any allergies, such as to scents or plant oils, so your massage will be relaxing and beneficial without that concern.

“Many athletes and weekend warriors put themselves under a great deal of mental stress in preparation for a competition,” says Pietrunti. “For many amateur athletes, this is exacerbated by other day-to-day stressors from their jobs, families and life. Sometimes, just setting aside an hour to relax and unwind can be a huge step towards better performance and quality of life.”


The skin does get flushed and warm, of course. That’s just superficial, cutaneous hyperaemia: capillaries in the skin respond to mechanical stimulation by dilating (which is likely an immune function: the body transports blood to the site of possible skin breakage). Blood is hot, so the skin gets quite toasty! But it’s clinically trivial and superficial only, and it has nothing to do with the intention of the claim that massage works by increasing circulation. BACK TO TEXT 

“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.
4. Coaching: once you have the breathing pace down, keep doing it while you move to this step. The key here is giving yourself positive, reassuring, and calm messages, rather than continuing with the tense, anxious, and angry thoughts. When I do this, I think things like "I can get through this. It will be OK. I can handle whatever happens. I am going to calmly do my best." Everyone will have a different way of doing this, and some people like to imagine this in the voice of someone they care about, or with the image of that person telling them those things. Keep doing this along with the breathing until you feel sufficiently ready to reconnect with what you were doing.
Low back pain is a huge health problem, and massage therapists claim to get good results when treating low-back pain. Indeed, low back treatments are the bread and butter of the profession. I’d guess that about 70% of massage purchases are for back pain. The amount of money that patients around the world spend on massage for back pain must be simply huge, at least in the tens of millions annually, and probably much more. As with chiropractic care, massage therapists might not have much of a business model if people didn’t have low back pain.
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?
If scientifically unsupportable practices are surprisingly common medical massage therapists, they are close to universal among barely-trained and untrained bodyworkers. Many of them aspire to greater skill, but usually don’t do so by studying orthopedics and physical therapy — a project that could occupy anyone for a lifetime — but instead by increasing their repertoire of certifications in proprietary hands-on techniques, most of which are either silly and/or medically unimportant (i.e. pleasant and harmless, but producing no significant therapeutic effect for any important health problem — hot stone massage would be a good example of this).
Make your own positive affirmations and repeat them outloud.  Often. Tell yourself that you are strong. Tell yourself that you are safe and that you will get through this. Positive affirmations have been proven to work in a few different ways. Knowing something is one thing, but actually hearing it time and time again from within yourself will result in a boost to your confidence. Make sure to join our 30-day affirmation challenge to get started!
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.
Think about how easy it is for a baby or small child to fall asleep. We're born with the instinct to relax and sleep when our bodies or minds need a break. Over the years, it becomes necessary to control and even suppress these natural urges to rest, because we must remain alert as we attend school, learn professions, go to work, or care for a family. Many people spend years conditioning themselves to perform well despite feelings of tiredness. While no one would argue that suppressing tiredness can be a necessary skill, it can impair our ability to actually "let go" and relax when we do find the time.

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And yet some medical benefits are plausible despite the lack of evidence. For instance, many apparently successful treatments may be due to the effects of pressure on “muscle knots,” which are a likely factor in many common pain problems, but poorly understood (and difficult to treat). And regardless, the effects on mood and mental health are so profound that patients can’t really lose — it’s a valuable service whether it “works” for pain or not.
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.

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.
Flushing. If massage can “improve” any tissue — unknown — one way it might do it is through simple hydraulics: physically pumping tissue fluids around, and/or stimulating the circulation of blood and lymph. I won’t get into the evidence about it here. Suffice it to say that it might be true, and if it’s true then it may not much matter if the process is uncomfortable. While gentler massage may feel pleasant and satisfying, it is possible that more biological benefits can only be achieved hydraulically — whether it’s comfortable or not. This is even more plausible because of trigger points: it’s likely that the tissue fluids of a trigger point are quite polluted with waste metabolites, and the need for flushing is greater, but it’s especially uncomfortable to squish those polluted patches of tissue.

For example, I worked on the Indiana Sports Massage Team starting in 1989, as well as the NCAA Swimming & Diving Championships and National Championships. I coordinated massage for the 1992 Olympic Trials and was on the 1996 Olympic Massage Team for the Atlanta Olympics—the first time massage therapy was part of the medical staff for the Olympics. These were all volunteer positions, but I loved it!
So obviously (duh) this infographic was designed to score medical credibility points for massage, and research was cherry-picked to support that goal, and there wasn’t any chance that any discouraging words or science was going to make the cut! But it something like this will get applause from almost everyone who sees it, because people love to love massage, because massage is a lovely experience for all kinds of reasons.
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.

Traction is a great example — pulling on the spine. Often used by massage therapists to treat low-back pain and neck pain, it might be an effective technique for a few patients, but I wouldn’t count on it, or advise anyone to spend much money on it. Like many popular therapies, the evidence is a mess.30 The absence of conclusive evidence is significant: if traction worked well, it probably would have shown up clearly by now. If traction works at all, it’s certainly not reliable. I discuss traction in considerable detail in both my neck pain and back pain tutorials. 

Well, so much for controversy! Massage probably has many interesting physiological effects … but getting rid of acid in your blood is certainly not one of them. Nor is drinking extra water going to help. On the contrary, as mentioned above in the myths section, massage is probably modestly “toxifying,” not detoxifying. Other articles delving into detox myths:
Although a lot of Bastian 2014 is certainly relevant to the concept of “good pain,” strictly speaking I don’t think they are writing about the good pain paradox, which is defined by simultaneous pleasure and pain. They are writing about pleasure following pain (relief from pain). This is more comfortable scientific ground: it’s pretty straightforward that relief from pain might be “associated with positive consequences” or lead to “activation of the brain’s reward circuitry,” for instance. Lance a boil, then feel better, right? Of course. But that’s definitely not what we mean by “good pain” in massage. BACK TO TEXT

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