• Why Do I Hurt After a Massage?

    The Obvious Suspects

    There are many reasons you might hurt after a massage. The most obvious ones are:

    • The therapist worked too deep
    • The therapist worked too fast
    • The therapist worked too aggressively

    These 3 things happen far too often and you generally know when they’re happening. Heck you might expect or even want them to happen, especially if you subscribe to the “no pain, no gain” philosophy. These three get the majority of the press when it comes to hurting after a massage, so I’m not going to spend much time on them today.

    However, just in case you’re not sure what too deep, fast, or aggressive might feel like, here’s a list of questions you can ask yourself while receiving massage or bodywork. A yes to any of these means you’ll likely hurt; probably the next day but perhaps the second day after.

    • Are you squeezing your eyes shut because of the pain?
    • Are you making a fist?
    • Are you curling your toes?
    • Do you find it difficult to speak normally?
    • Are you holding your breath?
    • Does your breathing resemble that of a woman in labor?

    The Not-So-Obvious Suspect(s)

    There are two other less known culprits that I do want to talk about today: Chronic inflammation and unresolved Inflammation. Both can involve a positive feedback loop where pain causes inflammation and inflammation causes pain. However, one can only be managed, whereas the other, with careful work, might be able to be resolved. So let’s take each one in turn.

    Chronic Inflammation

    Chronic inflammation can be things like:

    • Bursitis
    • Osteoarthritis
    • Fibromyalgia
    • Lupus
    • Metabolic syndrome
    • Rheumatoid arthritis

    Bursitis and arthritis are both local (contained in one area) conditions. The rest are systemic disorders, meaning they affect the whole body.

    It’s important to note that no matter whether it’s local or systemic, all inflammation manifests through the same processes, which I outlined last time in my post titled Should I Ice My Injury? The only difference is which part of the nervous system is controlling it.

    That said, local inflammation can become systemic and systemic inflammation can affect local areas. So one can become both and more than one part of the nervous system can get involved. Isn’t that fun and exciting? OK, not so much. It’s really kind of a drag, but it’s good info to know.

    Why? Because you might have chronic inflammation and not realize it. There are many diseases and conditions that have inflammatory components yet many people with these conditions are unaware of that fact. For instance, did you know that many cancers have an inflammatory component? What about Alzheimer’s? Parkinson’s? Type 2 diabetes? Osteoporosis? Atherosclerosis (hardening of the arteries)? A whole host of cardiovascular diseases? Yup. All of them, and many more, can have an inflammatory component.

    If you have any type of chronic inflammation, massage doesn’t have to be the super deep, fast, or painful type to give you a painful inflammatory flare up or turn a local issue regional or systemic. And that can make you hurt after a massage.

    Sad trombone.

    Luckily, with a skilled massage therapist or bodyworker, you should be able to continue to get massage without prompting an inflammatory flare up.

    Unresolved Inflammation

    Sometimes when there’s been illness or injury, the inflammatory cycle stalls. Maybe it’s because you used too much ice or maybe you pushed yourself through the repair and/or adaptation phase too quickly. Maybe something just went haywire in your body and it stalled for some random reason. Whatever the reason, the acute inflammatory response can then become chronic.

    If that happens, you’ll likely have a painful inflammatory response every time you get a massage, unless your therapist has the training, experience, pacing, and sensitivity to either not trigger it, or to trigger it in a limited and carefully controlled manner.

    If you are otherwise healthy and resilient attempting to restart a stalled inflammatory process can be beneficial and possibly even resolve the issue – depending on its severity. However, it’s important to know that in order for it to be beneficial it should resolve in 1-2 days. It’s also important to know that when restarting a stalled inflammatory process, it’s better to be a bit cautious and do more sessions that create mild to moderate inflammation rather than fewer sessions that result in large amounts of inflammation.

    It’s also worth noting that if you get repeated flareups from bodywork, that’s probably not terribly helpful… especially if you don’t notice a clear improvement after the flare has cleared. Remember, I’m talking inflammatory response so that means heat, redness, and swelling will all likely be present.

    What You Can Do for Chronic Inflammation

    If your chronic inflammation is flared up by a massage, you should let the current cycle play itself out (and maybe try a few of the ideas below). Then you should start managing it, and maybe talk to your massage therapist about changing the way they work with you. If they can’t or won’t change their approach, it’s time to find someone else.

    Managing your chronic inflammation isn’t going to be simple because everyone responds differently but there are a few things that are generally regarded as deactivating or slowing to the inflammation process. They include:

    • Pleasant or relaxing touch *cough*massage*cough* (not the deep, diggy, ouchy kind, though)
    • Rest
    • Sleep
    • Non-painful exercise and movement, or just to the edge of discomfort
    • Meditation or mindfulness practice
    • Laughter
    • Anything that helps lower your stress
    • Anything that helps enhance circulation of fluids in the body (both cardiovascular and lymphatic)
    • Staying hydrated
    • Keep moving in ways that aren’t painful and aren’t threatening
    • Isometric exercises

    By the way, all of the above activities are designed to counter our stress response because stress can be a major contributor to inflammation. So, even if you don’t have chronic inflammation or a stalled inflammatory cycle, you can still benefit from doing them. Which one(s) will you choose?


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