Six Unspoken Questions About Massage Therapy

By Robert Chute

Originally published in Body Sense magazine.

You love massage. But you’d love it more if you had the answers to a few questions you’ve been shy about asking. Good news! This article will address those questions you’d like to ask your massage therapist, but were afraid to ask.

I’m a bit uncomfortable taking everything off when I go for massage. Do I have to be completely naked to receive massage?

Some people go under the sheets without a stitch on, others wear underwear, and some people prefer to wear shorts, sweatpants, or even their regular street clothes. No, you don’t have to take off more clothes than you are comfortable with to receive massage. Talk to your therapist and they will adapt to your needs. Be aware that wearing more clothes can interfere with the use of certain techniques, but there’s no reason you can’t enjoy receiving massage in casual clothes. Therapists won’t be able to use lotion and may be unable to work as deeply, but they can adapt to your comfort level and still deliver a satisfying massage experience.

People who are self-conscious about their bodies might get massage more often, and with less apprehension, if they had the added underwear barrier. For some, it creates a psychological boundary that allows them to more fully relax during the massage, and that’s OK too. Rest assured, massage therapists work with all kinds of bodies, from the very young to the very old and all shapes and sizes in between. Massage therapists are a very caring and giving group. To be successful at what they do, they have to be. Your therapist strives to strike a balance between engaging with you as the complex individual you are, as well as seeing your body and all its unique qualities from a clinical perspective. Our work is about the careful application of techniques to your muscles, ligaments, and connective tissue as a means to enhance your whole being—not to judge you.

How do I talk to my massage therapist about money? I’d like to come more often, but it would be a financial hardship.

People would rather talk about their most embarrassing moments than talk about money. But if you feel your financial situation won’t allow you to receive further treatment, make sure you’ve considered your options.

If you’ve already taken a look at your numbers and still come up short, check with your employer or insurance carrier to see if you might be covered for massage therapy. Many people have coverage, but don’t know it. Conditions of acceptance for third-party reimbursement can vary because insurance coverage varies greatly. Conditions may include full or partial payment, limits on the conditions treated, a maximum number of allowed visits, or you may be required to get a doctor’s referral.

No coverage? There are still lots of options to discuss. Rather than drop massage from your budget (and life) altogether, consider coming in for shorter sessions. Another possibility, if you have some flexibility with your schedule, is to ask your therapist for a spot on their standby list. Your therapist might consider a discount fee if you can pop in for a last-minute appointment. Just like the airlines, sometimes clients cancel. Therapists typically sell their talents in one-hour increments and might be willing to fill the spot so they don’t have a hole in their workday.

Many therapists take credit cards and some will take postdated checks or a series of postdated checks to work out a payment plan. Some therapists have a sliding scale of fees depending on annual income and financial hardship, or they may accept coupons from bartering networks.

If you love massage and communicate to your therapist how much you value it, you might be able to work out an arrangement that’s fair to all parties.

I’m never sure about gratuities for massage services. What should I tip?

Massage therapists working in spas don’t usually receive the full fee charged for their services. They work on a percentage split with the spa owner or receive a salary. If you are visiting a spa, tipping is common (15–20 percent) and therapists may depend on tips for their income, just as restaurant servers do.

Your solo practitioner will likely appreciate tips as well, although not all massage settings accept tips (a doctor’s office with a practitioner who offers massage, for example). Bottom line is, if you feel like tipping, offer. If you don’t feel tipping is appropriate, don’t.

What should I do when I feel ticklish on the massage table?

Some people are sensitive to particular techniques, which make them feel uncomfortable and want to giggle. If that happens, your therapist may use a broader stroke or deeper pressure so it doesn’t tickle. In the unlikely event you’re still way too ticklish with those variations, the therapist can skip that part of the body and concentrate on less sensitive areas. It’s your massage, so you can withhold your consent for a particular area to be treated at any time and still receive a massage. Be sure to tell your therapist beforehand about any sensitive or particularly ticklish areas of your body so they can accommodate you more effectively.

Massage has to hurt to do any good, right?

This is a common misconception about massage. Delivering an effective massage is about technique over muscle. If it were all about muscle, massage therapists everywhere would be exhausted by noon and wouldn’t come back to work tomorrow. Professional therapists don’t work like cookie cutters, doing the same thing repeatedly and going to the same depth with every client, every time. We treat grandmothers with osteoporosis with much less pressure than a young athlete who prefers deep connective tissue work. Female therapists can work deeply, and even if your therapist is a large man, he can give a sensitive, light massage as well.

Massage does not have to hurt to help. You can gain therapeutic benefits from a relaxing massage, which doesn’t hurt a bit, or you can seek out more aggressive treatment options, which can cause some discomfort. Trigger point therapy and friction are examples of techniques that are briefly uncomfortable, but very helpful for many conditions. If you don’t want heavy pressure, say so. Massage therapists want to help you. If you’re wincing under the pressure and tightening up, that will work against the goals of massage, which is to invite your body to relax, reduce pain, increase well-being, and have long, supple muscles. Massage therapists aren’t in the torture business. Let your therapist know what feels good and what doesn’t. Recognize that your needs and pain threshold might change with each visit.

What if I get an erection during a massage?

It rarely occurs, but if it does, don’t panic. Sometimes as a result of your nervous system going into relaxation mode (or because of certain medications) erections happen. Therapists know that this is a physiological reaction and will treat the situation accordingly. Usually your therapist will try to redirect your attention with a shift in the focus of their work, maybe by altering pressure or moving to a different area of your body. Your unintended erection, and any embarrassment, will soon pass.

Any more unspoken questions for your therapist? Ask. Your honesty will strengthen your therapeutic bond with your caregiver and let you deepen your relaxation time and feeling of healing.

And that’s what it’s all about. You.