Does Massage Have to Hurt to Work?
By Kathryn Arbic, RMT
Registered Massage Therapist | ART® Certified Provider
Doctor of Veterinary Medicine (DVM)
Master of Arts in Counselling Psychology — Candidate, Yorkville University
"Can you go as deep as possible?" It's one of the most common requests I hear.
For many people, "deep tissue" has become synonymous with "effective massage." Somewhere along the way we've absorbed the idea that if we're not grimacing, holding our breath, or feeling sore the next day, then the treatment couldn't possibly have accomplished much. But is that really true? The answer may surprise you.
What does "deep" actually mean?
Contrary to popular belief, deep tissue massage isn't simply about using more force. It's about working with deeper layers of muscle and connective tissue when those tissues truly benefit from it. Sometimes that requires firm pressure. Sometimes it doesn't.
As a massage therapist, my goal isn't to "win" against your muscles. It's to understand what your body is communicating and choose the approach that best helps it move, recover, and feel safe.
Your nervous system matters
Pain science has taught us something incredibly important over the last several decades: pain isn't produced only by tissues. It's an experience created by the nervous system after it weighs many factors, including tissue health, stress, emotions, previous injuries, sleep, and even our expectations (IASP, 2020).
If your nervous system perceives a treatment as threatening, your body may respond by guarding (Bialosky et al., 2009). Muscles tighten. Breathing becomes shallow. You brace against the pressure. Ironically, the harder we push, the harder your body may push back.
Curiosity over endurance
The next time you're on the massage table, become curious.
Can you breathe comfortably?
Do your shoulders soften, or do they creep toward your ears?
Does the area gradually let go, or do you find yourself resisting the pressure?
There are no right or wrong answers. Learning how your body responds is part of the treatment itself.
So what makes a massage effective?
An effective massage isn't measured by how much discomfort you tolerated. It's measured by what changes afterward.
Perhaps you move more freely. Perhaps your headache settles. Perhaps your back feels less protective. Perhaps you sleep better that night. Or maybe, for the first time in weeks, you notice your shoulders aren't constantly up around your ears.
Those changes matter far more than how intense the treatment felt in the moment.
What does the evidence say?
Research consistently supports massage therapy as a helpful option for reducing pain and improving function for many musculoskeletal conditions. At the same time, studies have NOT shown that "more pressure" automatically produces better outcomes. Instead, successful treatment appears to involve matching the right technique, the right pressure, and the right person at the right time (Mak et al., 2024).
In other words, deeper isn't always better.
Finding the right approach
At Heritage Collaborative Care Centre, our goal isn't simply to apply more pressure—it's to understand why you're experiencing pain or restriction in the first place. Every person responds differently, and the most effective treatment is one that's tailored to your body, your goals, and how your nervous system responds.
Sometimes that means firm, focused work. Other times, a lighter approach allows muscles to relax more effectively. In many cases, combining hands-on treatment with movement, exercise, or education creates longer-lasting results than relying on pressure alone (Bialosky et al., 2009; Mak et al., 2024).
For example, Active Release Techniques® (ART®) is a specialized manual therapy that combines precise pressure with guided movement (ART, n.d.). Rather than trying to force a muscle to release through increasing intensity, movement helps target specific tissues while often allowing treatment to feel more comfortable and controlled. In my clinical experience, many clients are surprised that they can experience the feeling of 'deep work' without needing excessive pressure.
Whether you see a massage therapist, physiotherapist, chiropractor, or another member of our team, the focus is the same: helping you move better, understand your body, and find an approach that works with your system rather than against it.
Ultimately, the best treatment isn't defined by how much pressure was used. It's defined by whether it helps you return to the activities that matter most, with less pain and more confidence in your body.
References
Active Release Techniques. (n.d.). What is ART?https://activerelease.com/patients/
Bialosky, J. E., Bishop, M. D., Price, D. D., Robinson, M. E., & George, S. Z. (2009). The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model. Manual Therapy, 14(5), 531–538. https://doi.org/10.1016/j.math.2008.09.001
International Association for the Study of Pain. (2020). IASP revised definition of pain. https://www.iasp-pain.org/resources/terminology/#pain
Mak, S., Beroes-Severin, J. M., Cherkin, D. C., et al. (2024). Use of massage therapy for pain, 2018–2023: A systematic review. JAMA Network Open, 7(6), e2415738. https://pubmed.ncbi.nlm.nih.gov/39008297/
© 2026 Kathryn Arbic / Callisto Therapeutics. All rights reserved. Ottawa-Carleton Place, Ontario, Canada.
