Flushing. If massage can “improve” any tissue — unknown — one way it might do it is through simple hydraulics: physically pumping tissue fluids around, and/or stimulating the circulation of blood and lymph. I won’t get into the evidence about it here. Suffice it to say that it might be true, and if it’s true then it may not much matter if the process is uncomfortable. While gentler massage may feel pleasant and satisfying, it is possible that more biological benefits can only be achieved hydraulically — whether it’s comfortable or not. This is even more plausible because of trigger points: it’s likely that the tissue fluids of a trigger point are quite polluted with waste metabolites, and the need for flushing is greater, but it’s especially uncomfortable to squish those polluted patches of tissue.
Some possible justifications for painfully intense massage (these aren’t endorsements) include the destruction of motor end plates to “de-activate” trigger points; somatoemotional release (pain often strongly “resonates” with strong emotions like grief); moving tissue fluids; or just creating a strong, novel sensory experiences (which may have many subtle benefits).
“It is your body, your session, your outcome,” advises Rotenberger. “There’s a fine line between pain and discomfort, and it’s unique to the individual.” What’s more, deep pressure is not the same as deep tissue. It’s a common misconception, Rotenberger explains, and in reality, a therapist that is muscle-specific needs to exert little pressure to be effective.