A Reader Asks About Swelling After Massage

Update on 4/5/13: Oddly, this has been one of my most popular articles. Apparently a significant number of people are looking up swelling and inflammation after massage therapy on google. Maybe massage therapists need to ease up a bit.

I might need to revise the language of this just a little, but my answer is still essentially the same. My clients don't seem to complain of this and while the reader insists the pressure was not too hard, I suspect it was either more than the body tolerated well or it was treated for too long. I'm not sure what else to say.

A reader asks:

I received a great massage about a week ago but the next day my lower back was swollen. Why would this happen? The massage was perfect pressure and she never hurt me at all. Can you please help me understand this?

Without having been there or being able to ask follow-up questions, I can't give a definitive answer to your question. However, I'll take an educated guess.

It may have seemed that the pressure was perfect but it's possible that your body did not think the pressure was perfect. It may have been too much pressure. That's one possibility.

Another is that your back may have been overtreated. Massage therapists sometimes spend a long period of time in one area, thinking that every single tight fiber and sore spot must be relieved before they move on. It can even feel good to do it at the time but it may not be a good thing to do.

Massage sets a process in motion that continues after the session is over. Too much massage in one area can cause congestion, inflammation, and tightening of the muscles. A therapist should not work more than about ten minutes on one specific area. It is better to work a little, give the area a rest for two days, and then come back to it. It is always better to do too little than too much. Too little will do no harm but too much can cause irritation.

Did she put heat on the area after working on it? Massage will draw blood to the area. Adding heat will draw even more fluid to the area and cause congestion. Heat to warm the area before working on it can be good, but heat after an area has been thoroughly massaged can be too much.

Finally, it's quite possible that the swelling had nothing to do with the massage and was a coincidence. Perhaps something else occurred that you may not have been aware of. These things happen.

I've never had the experience of a client getting swelling after massage, but I did have an experience of too much massage creating congestion. I was in Latvia with my Russian Massage teacher Zhenya Kurashova Wine. We were at a clinic learning how massage was used in a clinic setting and we ourselves received treatment. Since we were foreigners and there for a limited time, we were getting more treatment than would have been normal. My arms were bothering me from overuse so I welcomed the opportunity to have them treated.

By the fourth day they began to feel congested. The therapist did not use a lot of pressure but the massage brought a lot of blood to the muscles. Zhenya always told us that muscles should be massaged like this only every other day, not every day, because it was too much. You bring the blood to the area and then leave it alone for a day to give the body a chance to do its work. When I told Zhenya my arms were feeling a little congested, she instructed me to skip treatment for a day. My arms began to feel better. I learned myself that more is not always better.

Yours is an uncommon response and so I don't know exactly why you had that experience. However, these may be some possible reasons why you had some swelling after your massage. Should this happen again, you might try putting ice on the affected area and ask your therapist to work more gently for less time on the area.

Thanks for your question.

Submitted byGuest (not verified)on Tue, 12/07/2010 - 5:58pm

Since the question is pretty vague, I would reply that the most common bodily response for someone who hasn't had massage in awhile is Delayed Onset Muscle Soreness (DONS).

How do they know it was inflammation? Maybe they are getting stiffness/soreness confused with inflammation. Since most of the superficial neuromuscular layers are an aponeurosis, inflammation wouldn't show unless you had an MRI or thermal imaging done.

It is VERY VERY VERY common to get sore after a massage (as all therapists know).

I have never heard of this congestion theory before. After reading this, I was very skeptical, so I tried to research it. Especially since massage increases lymph flow and white blood cell movement, I couldn't see how overuse could cause "congestion." That would suggest almost a clotting aspect, as if there were too many cells at a stand still. The same volume of blood itself will be throughout intrinsic vessels post massage. The cellular levels, however will change (for the better in a healthy body).

I could go on about this, but I won't. I would just suggest researching congestion due to too much massage.

I am, however, not arguing that too much massage in one area does aggravate the nerves, and irritates soft tissue. It can even cause the brain to splint muscle groups that are overused instead of relaxing them. This is a natural occurrence that protects joints by limiting range of motion.

With all that being said, my suggestion to the client would be to drink plenty of water and wait it out 1-2 days. If the pain subsides, it was most likely DONS.

Well, the reader didn't say she had soreness or pain, she said she had swelling. Not inflammation, but swelling. I agree this is baffling. I don't really have an answer for it.

Submitted byJoint Relief S… (not verified)on Tue, 10/01/2013 - 6:25am

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Thanks for your kind words. For better or worse, I'm responsible for all the writing here except for one guest article. I don't get paid for this, I do this because I love my profession. 

My webmaster, Jean Probert, designed and maintains the site. She does a great job. You can see her work as an illustrator at www.jeanprobert.com.

Submitted byGuest (not verified)on Mon, 10/07/2013 - 11:25pm

I am actually a LMT and had a massage on Friday. I like heavy pressure - but I have had back surgery a fusion to be honest. 20 minutes after my massage when i got to my office I had nausea headache an my low back was already swollen and it hurt to walk. I took some advil and put biofreeze on. It hurt to sit, to lay down and walk. today is monday and I am still really sore to the touch and swollen. I feel as though people that see the scars and the tightness in my back feel as though they can work it out and losen everything up. But there is bone in there that you cant work out and my muscles now accomadate for how my back has been for 23 yrs after surgery.

Yes, it really is possible to overdo it. I'd rather err on the side of caution. Fortunately, such discomfort is usually very temporary. Americans seem to think there has to be a lot of heavy pressure in order for massage to be effective or they will overwork an area. My Russian Massage teacher Zhenya cautioned us against that. I think she was right.