There’s rarely any justification for extremely painful massage, unless it clearly produces a better result than gentler treatment — which is rarely clear!1 It is possible that a few “brutal” deep tissue massages could do the trick where gentler treatment would fail — but there is no way to know this in advance, and massage is expensive stuff. If you’re going to gamble on a treatment, gamble on cheaper and less painful ones.
The benefits of a sports massage are numerous: improved flexibility, reduced risk of injury, and a boosted circulatory system, just to name a few. But bodywork isn’t a one-size-fits all tool, and there are certain things to consider before booking an appointment. Here, three runner-trusted massage therapists impart important pre-massage knowledge.   

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Diagnosing or treating disease would constitute the practice of medicine and would be illegal for anyone who does not have a professional license to do these things. Although many diagnose and treat disease, I am not aware of any prosecutions. In some states that license massage therapists, unlicensed reflexologists might also be prosecutable for practicing massage therapy without a license [11].

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Another alarmingly common example is the sensation of skin tearing. This has been inflicted on me personally on at least three occasions, and not by poorly trained therapists — quite the opposite, the perpetrators were all well-trained massage therapists doing a kind of “fascial release” therapy that they clearly thought of as an “advanced” technique.7
A 2004 systematic review found single applications of massage therapy "reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level", while "multiple applications reduced delayed assessment of pain", and found improvements in anxiety and depression similar to effects of psychotherapy.[54] A subsequent systematic review published in 2008 found that there is little evidence supporting the use of massage therapy for depression in high quality studies from randomized controlled trials.[55]

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