One of the most common things I hear from people in relation to Sports Massage is “No Pain No Gain”.
I think as a sweeping statement this is wrong, however, we need to look more closely about what it actually means.
Sports Massage on healthy muscle tissue should not hurt, however how many people come in to our clinics with 100% healthy muscle tissue? I can state with 100% confidence that even the professional TeamGB athletes, Premier League Footballers and top ranking sports people that come into our clinic in Manchester do not have 100% healthy muscle tissue.
Sometimes even the lightest massage stroke can hurt. Does that mean I should stop the treatment? No, because usually within a few seconds the physiological and psychological effects of the treatment will kick in and the pain should decrease.
What happens if I come across a Trigger Point? I put a little pressure on it and the client almost jumps off the bed. Do I leave it and let them suffer? Or do I explain the problem, the treatment, the potential Contra-Actions and After Care and proceed to treat; giving them an initial increase in pain for a few seconds, which subsides very quickly and resolves the painful Trigger Point?
Well if you ask any of the thousands of clients I have seen over the years, they will tell you they would much prefer a few seconds of discomfort, rather than days, weeks, months or even years of pain.
I have read in one Sports Massage book that Post Event Massage should “never hurt”, well I am not sure if the author has ever provided massage to people just after they have run a marathon, but I have, and I can say that it can hurt, but that is not the intention.
What all this boils down to is training. I have seen therapists get straight into unprepared tissue with fast deep strokes and cause the client to ask them to stop. That is not a good way to go about things. It can be counter-productive. Tissue needs to be respected, and strokes, speed and depth need to be adjusted to the needs of the client and the state of their tissue.
What about bruising? Sometimes, regardless of what people may tell you, bruising can occur, even with the lightest of touch. Does that make it wrong? No. As long as you have explained what you are doing, possible outcomes, and obtained ‘Informed Consent’, then as long as your intention is to heal rather than harm, and your treatment is appropriate, then Contra Actions are nothing to be ashamed of if they occur.
I have been working in therapy for over a quarter of a century and I find that training in Sports Massage can be so inadequate, many therapists are not even trained how to assess and adjust for depth, speed, pressure and technique, according to the state of the clients tissue and the amount of pain they may be in.
If they do cause bruising or increased pain, they may not know why, or how to adjust, or even how to treat the Contra-Action.
I know that Sports Therapists sometimes get criticised because some of the treatments can be quite painful – Trigger Point Therapy and Deep Transverse Frictions are two that spring to mind. But think about what they are treating – Trigger Points are in a nutshell, disfunctional and painful parts of a muscle (note the word painful); Deep Transverse Frictions are usually used on scar tissue (which is created as a result of damage – pain).
A good Sports Therapist will be confident enough to work within the client’s pain threshold, and skilled enough not to create more pain or damage – but that is because of the training they do. (I am not talking about basic level sports massage therapists here, but skilled advanced sports therapists, and well trained sports massage practitioners).
When I teach about Pain, I teach my students how to respect it, to work within the clients threshold, to always ensure that if we are creating an initial increase in pain, that it shouldn’t last too long (in the case of trigger points, we are talking seconds; in the case of deep transverse frictions, we are talking up to 2 minutes, in 10 second bursts) before the pain subsides. I also ensure that my students know how to deal with the after-effects of pain, so for example how to apply cold compresses, or give appropriate after care advice to ensure the clients knows how to deal with it.
So if anyone asks me should it be “No pain no gain”, my answer is, that is not our intention, however, it is sometimes a consequence that we should be able to deal with.
After all that, it is also important to mention that I don't use the term pain with my clients...but that's for another blog!
Richard Johnson Founder and Principal
Active Health Group