Reaction to Massage Procedure vs. Aggravation

by: Boris Prilutsky

By Boris Prilutsky

Statistically ten percent of cases clients complain that they feel more pain and stiffness after receiving a treatment than they felt before it. Many therapists might ask themselves why this happened and what was done differently this time compared to previous treatments.

The human body reacts to massage therapy differently. The desired reaction manifests itself in a number of beneficial that could be summed up as feeling of “wellness.” For example, if before the treatment on a pain scale from zero to ten a client reports the level 10, and after the treatment he/she reports that the level 8, the results are obviously positive.

In another scenario a client comes to a session complaining about chronic low-grade pain and limited range of motion in a region. After receiving a treatment he/she reports experiencing a much greater level of pain and stiffness.

In both cases, we witness the reaction of the human body to massage therapy. My grandpa, who was an expert on physical rehabilitative medicine, used to say, “If the patient didn’t react to the treatment, in my opinion, the treatment wasn’t performed.” In other words, the client has to react to the treatment with the feeling of either improvement or worsening of the pre-existing clinical picture.

The explanation for this increased intensity of pain is sudden and significant increase of arterial blood supply to the region. If one sits in an uncomfortable position for a while, this sometimes leads to a temporary decrease of arterial blood supply to the lower extremity. Upon changing position, the restriction of the circulation is removed, the arterial blood rushes through, and one suddenly feels tingles and pain in those lower extremities as the limb “wakes up”.

The reaction to changing position (significant increase of arterial blood supply) is temporary pain, tingles, etc. In some cases, the cardiovascular system of the individual reflects on massage with rapid and significant vasodilation that clinically manifested as a significant increase of arterial blood supply. Although this kind of reaction is not pleasant, it should not be seen as a negative phenomenon because the more blood supply is delivered, the better and healthier the tissue will be in the future. In the aforementioned case, usually a person feels very good immediately after the massage therapy occurs, but after approximately four hours, the pain sensation appears and can continue for the next twelve hours. After that, the person feels much better than before receiving treatment. This phenomenon can occur in reaction to orthopedic massage, full body stress management massage, etc.

Aggravation of condition

Reaction is a positive phenomenon that must never be confused with aggravation. Massage therapy is a physical method of treatment and therefore, when applied inappropriately, can aggravate the pre-existing condition or can cause new trauma.

For example, aggressive/vigorous massage therapy can cause trauma to the soft tissues resulting in myositis, development of trigger points, rib rotation or even fracture, facet joint subluxation, etc. Such aggressive massage could be a response to a client request to give him “harder or stronger” massage. The instructional medical massage educational video #12 describes and demonstrates techniques allowing to satisfy the client’s demand of “stronger” massage and yet to avoid causing the damage to the soft tissue. If you would like to get familiar with these technique please click here.

In some cases the client may unknowingly re-injure his/herself after the treatment. For example in the following scenario a client complains of stiffness and pain in the lower back region. The massage therapist performs protocols of massage therapy for the lower back region, the goals of which are to reduce tension in muscles and fascia, (to restore normal metabolism in soft tissue and to eliminate trigger points if they exist.) In a very successful outcome, the client can feel significant improvement and, sometimes, it is hard for him/her to believe that they got so much clinical improvement from one treatment. As a result they start moving fast trying to find if pain still exists; i.e. to “challenge” the improved range of motion. This kind of “innocent” testing can be extensive enough to re-strain and re-sprain the region. It is important to keep in mind that elevated tone of muscles and fascia over a prolonged period of time exhausts and weakens the anatomical structure of a region so that even innocent movement in increased range of motion could strain and/or sprain the region. (Strain is an overload, meaning that a person performed work that was too much on that particular region.)

Strain/sprain (overload/pulling) results in trauma or re-injury. Explain client why they should not challenge the region with vigorous movement and full range of motion for a while. Also instruct them to ease off their physical activities for the duration of treatment even if they feel improvement.

In cases of injuries, physical activities including therapeutic exercise programs have to be performed slowly, listening to the body and gradually increasing the amount of the activities. Usually in a frame of seven weeks, injured clients come back to normal physical activities with no limitation in the range of motion.

Another serious example of massage therapy aggravating the condition is the light prolonged massage therapy on clients who suffer from bronchial asthma. Patients who suffer from bronchial asthma the parasympathetic division of the autonomic nervous system is much more active than sympathetic activities. Prolonged light relaxation techniques significantly stimulate the already overactive parasympathetic division, which in turn can provoke severe asthma attack. Clients who suffer from bronchial asthma perform massage therapy techniques in an intensive, energetic manner (90-100 strokes per minute), similar to pre-event sport massage.

The practitioner who ignores the general rules of contraindication for massage therapy can aggravate the problem region and even endanger the client. For instance, massage of the carotid artery in general is counter indicated. In some cases of tachycardia (high pulse rate) doctors massage the carotid artery on purpose in order to reduce the heart rate. Please be aware that in cases of tachycardia only a physician and other specially licensed health care personnel can perform massage of carotid artery. A therapist performing massage on the neck region must be aware and careful not to massage the carotid artery because doing so can cause significant cardiac complications. Massage may dislodge the existing a blood clot trapped in the carotid artery, possibly leading to a stroke or even sudden death.
Another contraindication is a massage of moles, tumors and other bulgings. Sometimes we can palpate cysts, which could be cancer tumor formations. If one massages this formation on purpose it can actually cause the cyst to tear, resulting in serious complications such as the spread of cancer cells or lesions.

Energetic Status (condition) of Practitioner Can be a Factor

As we all know, electrical activities occur in our bodies 24/7. The central nervous system communicates with the peripheral nervous system to manage the functions of organs and systems through electrical impulses.

The constant electrical activities in our body create electromagnetic fields around us. Since electromagnetic fields are not impervious, it would only be right to assume that we could affect each other’s energetic status.

Experts in Chinese medicine believe that any disease is the result of blocks, stagnations and disturbances of the flow and distribution of life energy (Chi). There are reasons to believe that the nature of (Chi) is electromagnetic. Thus Western science, which deals with electrical processes in the human body, might possibly come to the complete agreement with methods Chinese medicine implemented from ancient times.

In order to help a client to restore normal flow of energy, a massage therapist must maintain balance of his/her own energy. If a therapist comes to the table with an imbalanced emotional/energetic status, he/she can perform the protocols correctly while as a client, instead of reacting with improvement and wellness, can experience aggravation – pain and stiffness all over the body.

To maintain a balanced status of energy, the practitioner must feel professionally confident. This professionalism comes from combining an understanding of the physiological effect of massage, the mindset of love and passion for healing, and the openness and humility of service to the well being of others.

Understanding and visualizing what you are about to do with your hands would significantly support the positive effects of hands on techniques.

Before beginning a hands-on session it is very important for practitioners to take at least 30 seconds – 1 minute to do a meditation to balance his/her own emotional status. I would recommend inhaling through the nose and exhale through the mouth and to imagine clockwise peristaltic function of the digestive system. Usually the above mentioned auto-training techniques help one to calm down, relax, and fully prepare oneself to perform a very beneficial massage therapy session with confidence.


A reaction on massage by temporary increase level of pain is not a negative phenomenon, but normal reaction for some patients to the treatment. The good news is that only 10% of clients react to treatment with a brief temporary increase of pain and stiffness etc., while 90% respond to treatment without any uncomfortable reactions. At the same time a massage therapist should be aware of possible aggravation and should always maintain good practices to prevent it.

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