The massage types that actually matter for chronic pain
The internet loves lists, but chronic pain hates oversimplification. So instead of “top five massages,” let’s talk about match-ups.
Deep tissue massage: Best for dense, load-driven tension
Deep tissue massage is for the person whose body feels dense, not delicate.
Picture a project manager who spends six hours a day in meetings, shoulders creeping up, head jutting forward toward the laptop. By 4 pm their neck feels like it has concrete poured into it, and their mid-back feels locked. They don’t describe it as a sharp injury. They describe it as “I can’t un-hunch.”
That’s the sweet spot for deep tissue work.
Used well, deep tissue massage targets the stubborn tension that builds from repetitive load and bracing. The goal is not to “break knots.” The goal is to lower protective muscle tone so the person can actually move differently afterward.
If the therapist’s plan is “more pressure equals more results,” that’s not deep tissue massage, that’s guessing with force. Effective deep work is slow, specific, and guided by your breathing and tolerance. A good practitioner will spend time on the upper traps, the muscles along the side of the neck, and the mid-back tissues that feel like they’ve been holding the posture for months, because they often have.
Deep tissue is also the quickest way to flare the wrong person.
If you’re the client who feels wiped out for two days after firm pressure, or whose pain is widespread and unpredictable, deep tissue is usually not the first move. In those cases, heavy pressure often teaches the nervous system to protect harder, not relax.
Remedial Massage: Best When There’s a Pattern You Can Name and Change
Remedial massage is not “a nicer massage.” It’s a targeted treatment built around a working theory.
Take chronic pain on the outside of the hip. The client gets told it’s “tightness” and receives general rubbing. The more useful question is: does it spike after long walks, after climbing stairs, or after lying on that side at night? Those are different patterns, and they demand different decisions.
A common scenario is a 45-year-old who feels lateral hip pain after returning to walking for fitness. It’s fine during the walk, then it aches later. They sleep on the sore side and wake up worse. That’s often a load and compression problem around the hip, not a “tight muscle” problem.
A remedial approach might look like this:
- – Targeted soft tissue work around the side of the hip, not just the painful spot
- – A quick check of single-leg control (can you stand on one leg without the hip collapsing inward?)
- – Clear advice for two weeks: stop sleeping on the sore side, avoid crossing legs, reduce long side-lying on that hip
- – Then strength work that gradually improves tolerance, because without it you’re just resetting symptoms every week
That combination is what separates remedial massage from a generic full-body session.
For chronic pain that has a repeatable trigger, remedial massage is often the most rational first choice because it’s anchored to assessment and follow-through. If your back always flares after a long drive, or your shoulder spikes after your first week back in the gym, a targeted plan beats a “let’s see how you feel” massage.
Swedish or relaxation massage: best when the pain system is noisy
Some chronic pain clients don’t need deeper work.
They need the alarm dial turned down.
A clear example is the person with tension headaches who clenches their jaw, holds their breath under stress, and sleeps poorly during deadlines. They tried a firm massage once, felt bruised, and spent the next day guarding their neck even more. That’s not “weakness.” That’s a sensitive, protective system.
In those cases, a gentler relaxation-style session is not fluff. It can be clinically sensible.
The mechanism is simple: predictable, comfortable touch plus slower breathing reduces guarding, which reduces pain sensitivity and headache frequency for some people. You’re not “fixing a knot.” You’re changing the state of the system.
If a client repeatedly flares after strong techniques, continuing to push intensity is poor clinical judgement. You build tolerance. You don’t demand it.
Trigger Point Therapy: Best When the Pain Travels and You Can Prove It
Trigger point therapy is useful when you can map the pain pattern, reproduce it, and then change it.
A scenario: someone has pain on the outer elbow that feels like tennis elbow. They’ve rested, iced, bought a brace, and it keeps nagging. Then you press into specific parts of the forearm muscles and it reproduces the exact ache down to the same spot. That tells you something. It suggests part of the pain is coming from muscle referral, not just the tendon.
Another common one is “shoulder pain” that’s actually driven by referral from the back of the shoulder blade region. A skilled clinician can often recreate that familiar pain by pressing into a specific muscle and then reduce it with targeted pressure.
That’s when trigger point work earns its place.
But it’s also easy to overdo. Ten minutes of hard pressure on multiple trigger points is a reliable way to cause a flare in someone whose system is already reactive. The win is not intensity. The win is precision plus dosage.
If your therapist can’t clearly explain why they’re pressing where they’re pressing, and what change they expect, trigger point therapy quickly turns into poking around.
Myofascial release: best for widespread stiffness and “non-local” discomfort
Myofascial work is most useful when symptoms don’t behave like a single tissue problem.
Think: whole-body stiffness, diffuse aching, pain that migrates, or a sense of restriction that doesn’t match joint range findings.
Someone with long-term low back pain plus tightness across abdomen, hips, and chest. They don’t feel a single “spot” that needs fixing. They feel globally guarded. Gentle, sustained fascial work combined with breathing and graded movement often outperforms aggressive pressure here.
This is also where pacing matters. The goal is not to overpower the system. It’s to invite change without triggering protection.
