Why Do You Feel Unwell After a Deep Tissue Massage? A Helpful Explanation from The Mark of Massage

Feeling unwell, sick, or “flu-like” after a deep tissue massage is surprisingly common—many clients experience it, especially after intense sessions or if it’s been a while since your last one. At The Mark of Massage in Castle Rock, Colorado, I’ve seen this since 2004 in therapeutic deep tissue, sports massage, and trigger point work. The good news: it’s usually temporary (24–72 hours), harmless, and often a sign your body is responding to the work. It’s known as Post-Massage Soreness and Malaise (PMSM), sometimes called “massage flu.”

Here are the main reasons it happens:

1. Muscle Soreness and Micro-Trauma (Like After a Workout)

Deep tissue applies firm pressure to deeper layers, breaking down adhesions (knots), deactivating trigger points, and realigning fibers. This creates beneficial micro-trauma—similar to delayed onset muscle soreness (DOMS) after intense exercise. Your immune system activates to repair tissues, causing inflammation, aches, fatigue, or general malaise that can feel flu-like.

2. Dehydration and Increased Circulation

Massage boosts blood and lymphatic flow dramatically. If you’re even mildly dehydrated beforehand (or don’t drink enough after), this sudden shift can cause:

•  Lightheadedness, dizziness, or nausea.

•  Headaches (especially if neck/shoulders were worked on).

•  Thirst, fatigue, or shakiness.

Muscles need extra water to flush metabolic byproducts (like lactic acid remnants) and support recovery—dehydration makes everything feel worse.

3. Mobilization of Metabolic Waste (Not True “Toxins”)

The old idea of “releasing toxins” is overstated (massage doesn’t flush environmental poisons or heavy metals). However, it does mobilize built-up metabolic waste from tense tissues into circulation. Your liver/kidneys process it faster than usual, which can temporarily overwhelm the system—leading to nausea, headache, fatigue, or mild flu-like feelings. This is more noticeable in deep tissue or when muscles were very tight/stagnant.

4. Nervous System Response (Vagus Nerve Stimulation)

Intense work (especially on neck, shoulders, or back) can stimulate the vagus nerve, which regulates heart rate, digestion, and relaxation. This may cause a sudden drop in blood pressure, lightheadedness, nausea, or queasiness as your body shifts into “rest and digest” mode.

5. Other Factors (Less Common)

•  Emotional release — Stored tension can bring up feelings or mild anxiety/sadness.

•  Overly intense session — If pressure was too much for your tolerance, it amplifies soreness/malaise.

•  Coincidence — Sometimes a virus was brewing (massage doesn’t cause illness but can make you feel worse if already fighting something).

These effects peak 24–48 hours post-session and fade quickly—most people feel better (looser, more energized) after.

How to Feel Better Faster

•  Hydrate aggressively — Drink extra water (aim for 2–3 liters the day of/after); add electrolytes if needed.

•  Rest & move gently — Avoid heavy exercise; light walking or stretching helps.

•  Use heat/cold — Warm baths/showers for aches; ice for sore spots.

•  Eat light & nourishing — Protein + veggies; avoid alcohol/caffeine/junk.

•  Communicate next time — Tell me if you’ve had this before—we can start gentler, blend lighter strokes, or adjust pressure.

If symptoms last beyond 3–4 days, feel severe (e.g., extreme nausea, swelling, dark urine), or you’re concerned, check with a doctor—rarely, intense work can overstress tissues (especially if dehydrated or with underlying issues).

In my practice—whether in-home mobile (within ~30 minutes of my home office at 216 Douglas Fir Ave, 80104) or private lower-level space (fully secluded sessions, occasional family sounds from upstairs outside the room)—I prepare clients for this normal response and tailor sessions to minimize it. It’s often a sign the massage hit the right spots!

Ready for your next session (with better prep for smoother recovery)? Book today—let’s get you feeling great.

Sources for Verification (based on 2025–2026 health and therapist resources):

•  Breeze Academy (2025): PMSM causes flu-like symptoms (headache, fatigue, nausea) from immune response to muscle repair, not toxins (https://breeze.academy/blog/can-deep-tissue-massage-cause-flu-like-symptoms/)

•  Cleveland Clinic: Soreness like post-workout; hydration/rest key (https://health.clevelandclinic.org/why-does-my-body-feel-worse-after-a-massage)

•  TMC Chiswick & Various Therapist Blogs: Metabolic waste mobilization + dehydration cause nausea/headache/flu feelings (https://www.tmc-chiswick.com/blog/why-do-i-feel-ill-after-my-massage/)

•  PainScience.com & Reddit r/massage: PMSM common; temporary malaise from circulation/repair (https://www.painscience.com/articles/poisoned-by-massage.php)

•  Healthline/WebMD: Increased circulation, vagus nerve effects, micro-trauma (various articles)

Your comfort and recovery are my priority—hope this helps! 😊