Why Do Some People Feel Worse the Day After Manual Therapy?

A Response That Can Feel Counterproductive

It is a reasonably common experience for clients to feel more sore, stiff or fatigued the day after a firm treatment session, even when the session itself felt beneficial at the time — understandably leading some to wonder whether the treatment has made things worse.

A Real, Measurable Tissue Response

Research examining the biological effects of massage after exercise-induced muscle damage found genuine, measurable changes in inflammatory and mitochondrial biogenesis signalling within the treated muscle following treatment — direct evidence that manual therapy produces an active biological response in the tissue, not merely a subjective sensation (Crane et al., 2012). A degree of transient post-treatment soreness is broadly consistent with this kind of real, if modest, tissue-level response to firm mechanical loading.

Distinguishing Expected Soreness From a Genuine Problem

Mild, generalised soreness that peaks within a day and resolves within 24–48 hours is a broadly normal and expected response to firmer treatment, similar in principle to delayed-onset muscle soreness after unaccustomed exercise. Soreness that is severe, sharply localised, or accompanied by swelling, bruising well beyond the treated area, or new neurological symptoms is a different matter, and should prompt a follow-up conversation with the treating clinician.