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The Onion: Why Pain Sometimes Moves Around as It Gets Better

Photo by Inge Poelman on Unsplash

So, you came in for a sore left shoulder.

After a session or two, the shoulder is quieter — but now your mid-back is complaining. Or your right hip. Or a spot on your neck you hadn’t noticed in months…

This is a pattern we see often enough that it deserves a name.

We call it the onion.

It is almost always a sign that treatment is working, not that something has gone wrong.

What’s happening when a new spot speaks up

Bodies prioritize. When one problem is loud enough, it drowns out quieter ones. The nervous system can only process so much at once, so it ranks its complaints and puts an emphasis on the worst one. That becomes what you feel. The rest are still there, but they’re running in the background.

When we reduce the sensitivity of the loudest spot — the trigger point that was referring pain into your shoulder, say — the ranking changes. A sore spot in your rhomboids that had been sitting at a four out of ten can suddenly register as a six, simply because it no longer has an eight to compete with.

The sensation feels new, but the spot isn’t new at al. It was there all along.

Central sensitization: why a body can be loud everywhere at once

There is a related piece to this worth knowing. Sustained pain — AKA Chronic Pain — can actually change the way the nervous system itself processes pain. The system gets more sensitive. Things that shouldn’t hurt start to hurt. Ordinary “light” pressure slowly becomes painful. This is called central sensitization, and it is well-documented in the pain science literature (Woolf, 2010; Mense, 2008). It is not imagined, and it is not a character flaw.

Central sensitization is part of why clients with one clearly identified problem often report that they seem to ache all over. Their “amplifier” has been turned up for so long that a lot of minor input feels major.

When we reduce the overall input — when the loudest source calms down — the amplifier often comes down too. That can produce what feels like widespread relief, even though we only worked on a specific area. It can also make quieter spots more noticeable for a while, because your nervous system now has more capacity to pay attention to them.

What this looks like in practice

A few patterns we see regularly at Brooklyn Body Mechanic:

  • A client comes in for what they thought was rotator cuff pain. After work on the back of the shoulder blade, the front of the shoulder calms down. One week later, they notice soreness in the neck on the same side that they had not registered before. On palpation, the neck spot behaves the same way the original one did.
  • A client with low back pain gets meaningful relief after work on the quadratus lumborum muscle. During their next visit, they mention that the opposite hip is now annoying them. That hip had been compensating for months. It is now the loudest thing in the room.
  • A client with tension headaches gets a run of good sleep after a session that calmed the suboccipitals. In the following week, they notice jaw soreness they had never paid attention to. The jaw had always been there. The headache was just always bigger.

In all three cases, the pattern shift is a signal. It tells us that the treatment plan is working, and we now have a clearer picture of what to address next in order to get to lasting relief.

How to tell the onion from an actual problem

The onion is not a license to ignore everything. Not every new sore spot is part of the same progression. Two rules to hold onto:

  1. The 50% rule. If a session leaves you more than about fifty percent worse than you came in, something went wrong and we want to know. What I normally tell clients is: “You might be a bit sore, but that should clear up in 24-36 hours. If not, email me!” Mild post-session soreness is normal. Significant aggravation is not.
  2. The good / bad distinction. Good pain is the satisfying ache of pressure on a real trigger point or tender spot — the “hurts so good” feeling. Bad pain is uncomfortable without being useful. It is sharp, electric, or alarming. Nerve pain, inflammation, or something we have not identified yet. This pain is not part of the onion. It is a stop-and-reassess moment, and sometimes a reason to see a physician.

If the new spot behaves like a trigger point — a sore band, consistent referral pattern, sensitive to slow pressure — it is very likely part of the progression. If it behaves like something else, tell us!

What progress actually looks like

A lot of clients come in expecting progress to feel like a straight line. I hate to be the bearer of bad news, but It is rarely linear. What we look for instead:

  • The same pressure hurts less on the spots we have been working.
  • The local twitch response to precise palpation gets smaller.
  • New spots become the priority — onion-peeling — which usually means the earlier ones are calming down.
  • You sleep better, move more easily, or return to an activity you had been avoiding.

Notably absent from that list: the felt “softening” of tissue under the hand. The idea that muscle texture tells you how much has changed is popular… it’s also insanely unreliable. We pay more attention to sensitivity and pattern than to whether something feels like a different kind of Play-Doh.

The short version: if the loudest problem has quieted down and a quieter one is now speaking up, the plan is working. Bring the new spot with you to the next session and we’ll fold it in.


References: Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2-S15. 

Mense S. Algesic agents exciting muscle nociceptors. Exp Brain Res. 2009;196(1):89-100.


What To Expect From Your First Session

How to Show Up for a Massage

So you’ve booked an appointment — what now?

First, you’ll get some forms sent to your email: A cancellation policy, a consent to therapeutic massage, and an intake form. If you’re a returning client, there’s no questionnaire but an option to leave updates/notes.

Our intake form is comprehensive for a reason: we want detail, nuance, health history, and an honest representation of what you’re coming in for. Why did you choose massage? This allows the verbal intake we’ll have before treatment to be streamlined—we’ll know what questions to ask to pinpoint exactly what needs to go into the treatment plan.

And importantly, the time you pay for is the time you’ll get on the table.

We care about who you are and what you need; detail-oriented care is our priority. You can show up in any mood, attire, or stress level. We can handle it all. What we really care about is that you show up willing and open to engage with the complexities of a massage.

What to Expect During a Session

We’ve made it to the table! Great. We’ll make sure the angle of the face cradle is comfortable, and that any bolsters needed are situated properly. You have the option of remaining clothed, or undressing to your level of comfort. No matter what you choose, consider the “bikini” template as areas that remain draped at all times.

That doesn’t prevent us from doing glute work, inner thigh work, hip work, or pec work, but it does set an immovable boundary. Bodywork mandates clear and communicated consent with a constant consideration for comfort and safety. From the trauma-informed angle, we will also often ask you: “Are there any areas of your body you would specifically like us to avoid?” You owe no explanation and we will abide by that request without question. 

Most sessions will start with a standard introductory touch. Then we’ll dive pretty quickly into our agreed-upon treatment plan. Don’t get me wrong, I’m a fan of frilly spa massages with add-ons and luxury, but that is a service with a preset template and a sole priority of pampering. Those experiences can be amazing, but it’s just not what we do. Most of the people we work with are frustrated by the impersonal nature of a spa massage and how it often neglects what you actually want worked on. It is far more fulfilling for us to curate something specifically for your needs.

Communication and autonomy during treatment

If you’ve gotten bodywork from me, I’m sure you’ve heard me say: “It’s your session, not mine.” This is not a stage for us to show off fancy skills, new techniques, or wax poetic about life (…very aware I do that last bit every now and then).

Seriously, though, it is a space for YOU to exist freely in your body, in your feelings, in your injury or pain, and you get to process however you choose. We can have silent sessions, chatty sessions, commiseration sessions, strategic sessions, the list goes on. We aren’t psychotherapists and that boundary will remain firm, but it is foolish to separate the mind and body—pain is multifaceted so we treat it as such.

It is paramount to dispel the notion that just because you are on the table does not mean you aren’t in charge.

You ALWAYS have the option to say that something is too much, not enough, that you’d like to approach something differently, or that something feels great and not to move an inch. We’re great at our jobs, but you are the expert on your body and so we communicate and adapt as such. It’s called the therapeutic alliance for a reason: we work together. It’s collaborative. A successful session includes trust going both ways! We trust that you are engaging with the sensations as they come, and you trust that we are prioritizing your well-being at all times. 

How to take care of yourself after a massage

Pain decreases with decreased fear.

A goal of ours during treatment is to cushion the weight of chronic, injury-related, or acute pain. Intensity is often alleviated by a kinder mindset towards our bodies. We carry so much, and it is much harder to receive a massage than it is to give one. No matter if you’re coming in for a strictly “sports” massage (stay tuned for an entry on modalities) or an emotional/somatic-focused session, you as the receiver are doing the hard work of feeling it all. Letting go with some aftercare does wonders, so we’ll give you some tips and tricks at the end of the session and we always recommend approaching the rest of your day with an extra dose of care. Drink a bit extra water, replenish with some good food, and pay a little extra attention to how you feel in your body. Hopefully, some things have changed, some movement is easier, and some stress is alleviated. 

Thank you so much for reading and please reply with any commentary on your experience with bodywork, things you wish you knew, or what you wish practitioners did more often!


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