Sports massage is widely used by athletes, active individuals and even inactive individuals in pain to help with pain relief, recovery, and performance. However, many misconceptions persist about why massage works and how it should be applied. Some therapists still promote the idea that deep pressure, pain, and even bruising are necessary for effectiveness, while others tell clients they feel “tight” and need multiple sessions.
Let’s break this down with an evidence-based approach—acknowledging the real benefits of massage therapy while dismantling some common myths.
Does Sports Massage Really Break Down Knots?
One of the most persistent myths in massage therapy is that it physically breaks down muscle knots, realigns muscle fibres, or releases fascia. This idea has been largely debunked by research. Studies on soft tissue mechanics show that manual pressure does not physically alter muscle tissue or fascia in the way some claim.
Instead, the sensation of muscle “knots” is likely due to:
Changes in nervous system sensitivity (increased muscle tone or guarding)
Trigger points (nervous system hypersensitive spots in muscle)
Perceived tightness rather than actual shortening of the tissue
Massage doesn’t “fix” these mechanically, but it modulates how the nervous system processes pain and tension, which can provide relief.
Why Do People Feel Better After a Painful Massage?
Many people report feeling better after a deep, sometimes painful massage. But pain doesn’t equal effectiveness—and bruising is definitely a sign of excessive pressure.
So why do people feel relief? There are a few key mechanisms at play:
Gate Control Theory of Pain – The nervous system prioritises strong sensory input (like deep pressure) over pain signals, temporarily reducing discomfort. This is why rubbing your elbow after you bump it makes it feel better — the new input distracts your nervous system from the pain. Painful sports massage does the same thing, creating temporary relief without addressing the underlying cause of the pain.
Endorphin Release – Deep pressure can stimulate endorphins, serotonin, and dopamine, which provide a temporary sense of relaxation and well-being. These chemicals help reduce the perception of pain and create a post-massage “high” that feels like relief. But just like with a tough workout or an ice bath, this sensation is temporary. The endorphin rush masks discomfort without actually resolving any tissue damage, tightness, or dysfunction.
Descending Modulation - Your brain has an incredible ability to adjust how it processes pain signals. Descending modulation is the process where the brain decides to dampen or amplify the pain signals it receives. Painful massage can sometimes trigger this protective mechanism — the brain decides, “Ok, enough pain; let’s dial it down” — leading to short-term relief (Tracey & Mantyh, 2007). But this doesn’t mean the problem is fixed; it just means your brain has temporarily turned down the volume on those signals.
Parasympathetic Activation – Intense massage can trigger a sympathetic nervous system response — the fight-or-flight mechanism. Your heart rate increases, your muscles tense up, and adrenaline floods your system. Once the session ends, your parasympathetic nervous system takes over, bringing a surge of calm and relaxation. This contrast between stress and relaxation can feel like a massive relief, even if the massage itself caused additional irritation or inflammation.
Expectation and Placebo Effect – Never underestimate the power of belief. If you expect a painful sports massage to help, your brain is more likely to interpret the session as effective. Research shows that the placebo effect can significantly influence pain perception and recovery (Benedetti et al., 2005). This isn’t to say that the relief isn’t real — but it’s not because your muscles have been "released" or your fascia has been "broken down". It’s because your brain’s expectations shape your experience of pain. If a person expects a deep massage to work, their brain may generate a pain-relieving response.
This means painful massage isn’t necessary for effectiveness, and excessive pressure can actually cause more harm than good leading to increased sensitivity, tissue damage, or prolonged recovery times.
Sports Massage Therapists and the “Tightness” Myth
If you’ve ever been told, “You feel really tight, you’ll need a few sessions,” you may have questioned what that actually means.
“Tightness” is a vague and subjective term. It doesn’t always correlate with actual muscle stiffness or reduced range of motion. Sometimes, people feel tight due to:
Nervous system sensitivity (the brain interpreting certain areas as stiff)
Psychological stress (stress can increase muscle tension)
A lack of movement or mobility work
The idea that you “need multiple sessions” can sometimes be more of a business model than a clinical necessity. While ongoing care can be beneficial, it should be based on individual needs and goals, not a one-size-fits-all approach.
What Massage Therapy Does Well (The Science-Backed Benefits)
While massage may not be "breaking down knots," it still has valuable effects when used appropriately:
✅ Nervous System Regulation – Helps switch the body to a parasympathetic state, reducing stress and muscle guarding.
✅ Pain Modulation – Activates sensory pathways that temporarily reduce pain perception (Gate Control Theory).
✅ Circulation and Fluid Movement – Encourages blood flow and lymphatic drainage, which may aid recovery.
✅ Proprioception & Body Awareness – Enhances your awareness of how your body feels and moves, which can improve movement patterns.
✅ Psychological Benefits – Touch therapy is linked to reduced anxiety, improved mood, and better sleep.
When combined with strength training, mobility work, and proper load management, massage can be a great complementary tool for recovery and well-being.
The Takeaway: Massage Is Valuable, But Let’s Be Honest About Why
Massage therapy has real benefits but they come from nervous system responses, not mechanical tissue changes.
Painful, bruising massage is unnecessary and counterproductive.
You don’t need multiple sessions unless there’s a clear, personalised reason.
Tightness is subjective, not always a structural issue.
Massage is best used alongside strength training, movement, and recovery strategies.
By shifting the conversation toward science-based mechanisms, therapists can provide more effective, ethical, and empowering treatments for their clients.
References:
Aboodarda, S. J., Spence, A. J., & Button, D. C. (2015). "Pain adaptation response to eccentric exercise with blood flow restriction." Medicine & Science in Sports & Exercise, 47(2), 289-296.
Benedetti, F., et al. (2005). Placebo effects: Understanding the mechanisms in health and disease. Nature Reviews Neuroscience, 6(7), 545-552.
Bialosky, J. E., Bishop, M. D., & Cleland, J. A. (2010). "Mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model." Manual Therapy, 15(5), 344-354.
Melzack, R., & Wall, P. D. (1965). "Pain mechanisms: A new theory." Science, 150(3699), 971-979.
Schleip, R. (2003). "Fascial plasticity–A new neurobiological explanation: Part 1." Journal of Bodywork & Movement Therapies, 7(1), 11-19.
Sprouse-Blum, A. S., et al. (2010). Understanding endorphins and their importance in pain management. Hawaii Medical Journal, 69(3), 70-71.
Tracey, I., & Mantyh, P. W. (2007). The cerebral signature for pain perception and its modulation. Neuron, 55(3), 377-391.
Vigotsky, A. D., et al. (2015). Biomechanical perspectives on myofascial trigger points. Pain Research and Treatment, 2015, 1-12.
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