04/02/2026
Does Treatment Have to Hurt to Work? (Short Answer: No)
In sport and rehab, the phrase “no pain, no gain” is everywhere. And understandably, a lot of people bring that mindset into sports massage, injury rehab, deep tissue work and soft tissue therapy.
I regularly hear things like:
“I want it deep.”
“Don’t worry — I can take the pain.”
“It needs to hurt to work, right?”
But clinically, pain during treatment doesn’t tell us that tissue is changing — it tells us the nervous system is feeling threatened. And when the nervous system feels threatened, healing tends to slow down rather than speed up.
What Actually Happens When Treatment Hurts
When pressure becomes painful, the body doesn’t relax into it — it braces against it.
That looks like:
Muscles tightening instead of softening
Breath holding
Increased sensitivity in the area
A stress response rather than a recovery response
From a rehab perspective, that’s not the environment we want if the goal is improved movement, healing, and long-term recovery.
Why Aggressive Soft Tissue Work Can Be Counterproductive
If tissue is already irritated, overloaded or sensitised, aggressive pressure can:
Increase protective muscle tone
Prolong symptoms rather than settle them
Reinforce pain pathways
Leave people sore enough to avoid movement or training
Reduce confidence in using the area again
In persistent pain cases especially, this kind of approach can actually increase sensitivity over time rather than reduce it.
“But I’ve Had Painful Massage That Really Helped Me…”
This is probably the most common (and reasonable) question I get — and the answer is: yes, that absolutely happens. But it doesn’t mean the pain itself was the thing doing the healing.
A few reasons people often feel better after painful treatment:
1. Nervous system effects
Strong pressure can temporarily reduce pain sensitivity — similar to rubbing a sore area. That’s a neurological response, not tissue being “broken down”.
2. Endorphins
Painful stimulation can trigger endorphin release, creating a sense of relief afterwards.
3. Expectations
If you expect deep pressure to work, the brain often delivers improvement — context matters more than most people realise.
4. Natural recovery
Many musculoskeletal issues improve with time, movement and load management regardless of treatment.
5. Therapeutic touch
Being listened to, supported and physically cared for has genuine physiological benefits.
So yes — people can feel better after painful massage. But that doesn’t mean pain was necessary for that improvement.
What I’m Actually Aiming For in Treatment
Clinically, I’m looking for pressure that feels:
✔ Strong
✔ Comfortable
✔ Safe
✔ Something you can breathe and relax into
Not: ✖ Grit-your-teeth
✖ Brace-and-hold-your-breath
✖ “Just push through it”
When the nervous system feels safe, tissues respond better, movement improves more easily, and recovery tends to stick.
So… Is Pain Ever Useful?
Pain itself isn’t the enemy — but chasing pain isn’t the goal.
The goal is:
Better movement
Better loading tolerance
Better confidence in your body
Better long-term outcomes
And that happens most reliably when we work with the body instead of trying to force it into change.
Bottom Line
If treatment hurts, it doesn’t automatically mean it’s wrong — but it doesn’t mean it’s right either.
Good therapy isn’t about how much discomfort you can tolerate. It’s about helping your body feel safe enough to recover.
📚 REFERENCES (Evidence-Based & Client-Safe)
Bialosky JE et al. (2009). The mechanisms of manual therapy in the treatment of musculoskeletal pain. Manual Therapy.
Moseley GL & Butler DS. Explain Pain. Noigroup Publications.
Nijs J et al. (2012). Treatment of central sensitization in patients with chronic pain. Pain Physician.
Lederman E. (2010). The myth of soft tissue manipulation. Journal of Bodywork & Movement Therapies.
Field T. (2014). Massage therapy research review. Complementary Therapies in Clinical Practice.
