Originally published in Massage Bodywork magazine, September/October 2010. Copyright 2010. Associated Bodywork and Massage Professionals. All rights reserved.

Mary Kathleen Rose: Awhile back I gave a presentation on the benefits of massage to members of a community service club. When I opened up the discussion for questions, one woman tentatively raised her hand and asked, "Is massage supposed to hurt? I had a professional massage once, but it was painful, so I didn't go back." I told her no, massage need not hurt to be effective.

Mary Ann Foster: It's surprising how many people perceive massage as a painful therapy. Some massage therapists and clients believe it needs to be painful to be effective, so how many people avoid massage because of their fear of being hurt?

MKR: Yet, it is ironic that in some circles massage has a reputation for being painful when a primary reason people receive massage is for relief from pain and discomfort.

MAF: I think this paradox stems from confusion between skillful deep-tissue work and poor technique. Many clients comment that deep pressure on tense muscles "hurts so good." It seems that the "good" pain people crave occurs during the release of chronic muscle tension; whereas the pain people avoid is inflicted by insensitive technique. If the work is too deep or inappropriate, it can damage tissue and elicit a guarding response, both of which will lead to more discomfort and stress.

MKR: Pain is a subjective experience. Addressing pain needs to be client-centered, not only because people's perceptions of bodily sensations differ, but because there are so many diverse physiological and psychosocial factors that contribute to the experience of pain. Bodyworkers tend to focus on neuromuscular pain associated with muscle spasm, but other causes of pain include inflammation, illness, injury, or emotional distress.

MAF: Each cause requires a different approach. People who live with pain from chronic illnesses, such as arthritis, lupus, and fibromyalgia, may have difficulty with massage therapists trying to alleviate their symptoms with neuromuscular techniques. As a result, these people are reluctant to get massage because they fear leaving with more stress than they had when they came in.

MKR: A woman in one of my workshops shared recently her experience of receiving a massage in which she asked the therapist to lighten up because it hurt. The bodyworker said, "Do you want to keep your pain or let it go?" The woman wondered, "Why am I paying for this abuse?"

MAF: Pain is hard enough to cope with, but inflicting it on a client, then projecting it as the client's problem, just adds insult to injury. Our job as bodyworkers is to listen to what our clients need and to respond to their feedback as we work on them. If clients ask us to lighten up--no matter what we think they need--we must respect their request.

MKR: The challenging part of working with pain from muscle tension is to figure out the right technique, pressure, and rhythm for each situation. Deep pressure into the belly of a tender muscle needs to be slow enough to give clients time to tune into the area so they can relax under the pressure.

MAF: Slow, consistent contact with the client, both through touch and verbal rapport, is so important. When a practitioner works slowly, clients know they are not going to get hurt, so it builds trust.

MKR: No matter the etiology of the pain, I tell my clients to let me know if anything is uncomfortable or causes more pain for them, and I will adjust my technique accordingly.

MAF: Some clients have warned me that they "Don't want to breathe into pain" or "Rate their pain on a 1-10 scale when trying to relax!"

MKR: Clients in pain have enough to deal with without having to manage the practitioner or be on guard. They need a safe place to process painful sensations, while trusting that the practitioner will do no harm.

MAF: Working with people in pain can be very humbling because massage has its limits. We can't always relieve pain, but with respect and compassion for our clients, we can offer our best in the way of a soothing and comforting touch.

Mary Kathleen Rose, BA, CMT, has been practicing shiatsu and integrative massage since 1985. She is the author of Comfort Touch: Massage for the Elderly and the Ill (Lippincott Williams Wilkins, 2009). www.comforttouch.com.

Mary Ann Foster, BA, CMT, specializes in movement education for massage and is the author of
Somatic Patterning: How to Improve Posture and Movement and Ease Pain (Educational Movement Systems Press, 2004). www.emspress.com.