Feeling unwell after a massage, sometimes called post-massage malaise, is a common and often surprising experience. Instead of relaxation, some people experience temporary fatigue, headaches, mild nausea, or muscle soreness similar to the beginning of a cold. This temporary feeling of “sickness” is generally not a sign of actual illness, but a normal, short-lived physiological reaction to the intensive manipulation of soft tissues. The body’s systems require a brief period of adjustment after responding to the work done on the muscles and connective tissues.
Understanding the Body’s Reaction to Deep Tissue Work
The primary reason for feeling unwell is the mobilization of fluid and metabolic waste products within the body. Deep tissue work physically increases blood and lymph circulation, forcing stagnant fluids and cellular byproducts, such as lactic acid and urea, out of the constricted muscle tissues and into the bloodstream. This sudden influx of metabolic waste temporarily increases the load on the liver and kidneys, which are responsible for filtering and eliminating these substances.
This temporary systemic increase in waste can lead to flu-like symptoms, including fatigue, a slight headache, or a general feeling of being “off.” Additionally, the firm pressure applied during deep tissue massage can trigger a minor, localized inflammatory response. This involves the release of chemicals like histamine, which widens blood vessels to increase blood flow to the area, but can also contribute to malaise or minor skin flushing.
The nervous system also undergoes a significant shift that contributes to post-massage fatigue. Massage therapy promotes a switch from the sympathetic nervous system, the “fight-or-flight” state, to the parasympathetic nervous system, the “rest-and-digest” state. This rapid transition causes a drop in stress hormones like cortisol and a reduction in heart rate and blood pressure, which can manifest as sudden, profound tiredness, lightheadedness, or a “zoning out” sensation.
Dehydration often exacerbates these symptoms. If the body is low on fluids, the increased fluid shifts and the kidney’s need for water to process mobilized waste products can lead to a more severe headache or pronounced nausea. The physical manipulation of muscles can also create micro-damage similar to a strenuous workout. This results in delayed onset muscle soreness (DOMS), which feels like muscle aching or stiffness and can be mistaken for an early flu symptom.
When to Consult a Doctor About Post-Massage Symptoms
It is important to distinguish between normal post-massage effects and symptoms that require medical attention. Normal reactions, such as mild muscle soreness, light fatigue, or a slight headache, are transient and should resolve within 24 to 48 hours. Temporary dizziness or nausea that subsides quickly after resting and drinking water is also not a cause for concern.
You should seek immediate medical advice if you experience symptoms that are severe or persist beyond the expected two-day window. Warning signs include a high fever, persistent vomiting, or severe localized pain that worsens instead of improving. Sharp, shooting pain, numbness, or tingling that radiates into your limbs could indicate nerve irritation and should be evaluated by a healthcare professional.
Other serious but rare symptoms include unexplained skin rashes, signs of an allergic reaction like difficulty breathing, or swelling in the limbs. Extremely dark urine accompanied by intense muscle pain and weakness could suggest rhabdomyolysis, which requires urgent medical assessment. If you have a pre-existing condition, such as a history of blood clots or cardiovascular issues, monitor your response closely and consult your physician if any symptoms feel unusual or alarming.
How to Reduce the Likelihood of Feeling Sick Afterward
Proper hydration is one of the most effective ways to minimize post-massage symptoms. Start increasing your water intake several hours before your appointment to ensure your tissues are well-hydrated. Continuing to drink water steadily for the rest of the day post-session helps your kidneys efficiently flush the mobilized metabolic byproducts.
Communicating openly with your therapist is also a powerful preventative step. You should inform them of any pre-existing health conditions and let them know immediately if the pressure feels too intense or painful. Overworking a muscle can significantly increase the likelihood of post-treatment soreness and malaise.
Immediately after the session, prioritize rest and avoid strenuous activity. Giving your body time to remain in the parasympathetic state allows for better recovery and integration of the work performed. Soothing measures, such as taking a warm bath or using Epsom salts, may help ease muscle soreness. Eating a small, light snack one or two hours before your massage can also help prevent lightheadedness or nausea caused by low blood sugar.