Join our email list for launch updates.
Oct 9 • T. MaShae Pearson

Does Massage Have to Hurt to Help?

Does massage have to hurt to be effective? Explore how massage therapists can discuss pressure, respond to discomfort, and use client feedback to guide comfortable, individualized sessions.
“It hurts, but that means it’s working, right?”
Many massage therapists have heard some version of this question. Some clients expect an effective session to feel intense. Others believe soreness afterward proves they received a thorough treatment.
Those expectations create an opportunity for a useful conversation. Pain during a massage should not be treated as proof that the work is effective. A client’s goals, comfort, health history, and response provide a better foundation for choosing an approach.


Start by clarifying what "deep pressure" means

When a client requests deep tissue work, ask what they hope to accomplish.
They may want focused attention to a particular area, relief from a familiar sensation, or simply firmer pressure than they received during a previous massage. Those requests can lead to different session plans.
Useful questions include:

- “What would you like to feel or do more comfortably after today’s session?”
- “What has worked well for you during previous massages?”
- “Was there anything about your last session that you would prefer we change?”

These questions turn a general request into a more useful conversation about preferences and goals.

Make feedback easy

“Let me know if it hurts” is a start, but a more specific invitation can make speaking up easier.
Try:
“You can ask for less pressure, a different technique, or a pause at any time. You don’t need to push through discomfort.”

During the session, offer clear choices:
“Would you like this pressure lighter, the same, or firmer?”

If a client reports discomfort, acknowledge it and adjust. Avoid explaining away their experience with statements such as “That means we found the problem” or “It has to hurt before it gets better.”
The client should feel comfortable changing their mind throughout the session.

Use discomfort as a reason to reassess

Consider a fictional client who requests firm shoulder work. As pressure increases, they tense their body and say, “I can take it.”
Rather than treating that statement as a goal to maintain intensity, the therapist could pause and ask:
“Would you prefer less pressure or a different approach? We can adjust this.”

The next step might involve reducing pressure, changing positioning, trying a different technique, or stopping work in that area. The decision should reflect the client’s feedback and whether continuing is appropriate.
Massage generally has a low risk of harm, but it is not risk-free. NCCIH reports rare serious adverse effects, with some cases involving vigorous massage or people at increased risk of injury. That supports thoughtful screening and individual decisions about pressure.

Review results beyond the treatment table

A useful follow-up conversation explores how the client responded.
Ask whether they noticed a change in the concern that brought them in, whether the session felt comfortable, and whether anything afterward affected their usual activities. Their answers can help guide future sessions.
Avoid promising a particular result. NCCIH notes that massage may help with some pain conditions, but the strength of the evidence varies and benefits may be short term.


Bring the conversation back to the client

“We can work toward your goals while adjusting pressure to your comfort. Please tell me if anything feels painful or if you want me to change what I’m doing.”

That response creates room for communication, choice, and ongoing assessment—the habits that help therapists make thoughtful session decisions.
At PALM CE, we explore these conversations through practical continuing education focused on pain science, consent, and clinical decision-making in massage practice.
Created with