What differentiates pain-management massage from massage therapy?
While we can invest in hands-on skills for effective pain-management techniques, it is equally as important to learn how to understand and work with the client’s interpretation of pain, perspective and expectations—and how they impact acceptance and success of those skills.
These hands-off pieces play a huge part in how successful pain-management massage therapy is received by your client.
Just to be clear, I am not going to attempt to define the divisionary lines for different types of bodywork and create categories or classifications of massage. I’m not sure if that is realistic or necessary to attempt.
Massage in general has evolved into its own classification of a healing art form and I believe it is our vast diversity that offers us the ability to create these holistic outcomes for our clients.
The Client’s Idea of What Pain Management Means
What most clients want when they are asking for pain-management massage therapy is not a specific technique. It’s a specific outcome that they believe you, not necessarily the technique, will provide for them.
When clients are willing to be upfront and vocal about their expectations, they will tell you that they want their pain gone completely—100%—and they are placing that expectation on you, with the hope that your knowledge and skill will create it for them.
What they are looking for is someone to touch their pain, ease their pain, find solutions to their pain, take their pain away, help them understand why they have pain, or to understand why the medical treatments failed them.
These clients want relief and help with a condition that they are struggling to control or find relief from. And because they are typically paying out of pocket for these treatments, their commitment only goes as far as they can afford your services.
Clients in pain may not fully understand the limitations we are faced with as massage therapists to create this level of change with only our minds and our hands.
That is a lot of responsibility to place on the shoulders of a massage therapist. Nonetheless, this is a small example of what we are facing when someone is requesting pain management massage therapy.
I have spoken with many therapists who have experienced burnout and left this career because of this perceived responsibility or sustained work-related injuries from working harder, deeper, or longer in the attempt to meet those unrealistic expectations.
If this sounds like the space you are in, you feel the weight of these words every day. I have been in this space and strive to not be while continuing to offer the best that I have for my clients. I want to offer you a way to unburden yourself from that expectation while continuing to help those on your table.
Concept #1: Advanced Pain Management Begins with Education
When I learned how to re-set client expectations to be in line with what I could realistically offer them, I began to see amazing things happen. It was interesting to me that when I was struggling to meet high expectations, success was limited.
When I took the time to set the expectations as a team, the client and I could meet them, and we both observed much greater levels of success with managing pain.
Some of the expectations I offered clients had to do with:
• Knowing what to realistically expect from the massage treatment, including potential increases in pain as the body healed.
• How to observe and then communicate changes felt between sessions that offered positive feedback needed to adjust treatment.
• How to communicate during the session to adapt to what the body needed.
• Education about how massage therapy works as a treatment option and also how it fits into a wholistic approach to wellness.
• A wellness model which for all intents and purposes is about honoring your body and its needs.
• How to use a pain scale to judge treatment effectiveness and to determine a schedule that allowed for best treatment selection.
• As you can see, effective pain management is part education and part actual reduction in pain to the extent that the client can observe and feel the difference to continue to get treatment. It’s about co-creating the opportunity for change.
Concept #2: Deep Tissue Does Not Equate Deep Change
I remember one of my teachers telling me that going deeper did not necessarily mean to push harder. At the time, I didn’t have enough experience to really understand what that meant.
It took failure and success with pain clients to understand that harder pressure is often more damaging to clients in high levels of pain and inflammation. This creates a bit of a challenge for therapists, clients and expectations.
Clients commonly request deep tissue from you when they are in higher levels of pain. It is a natural tendency to believe that to ease the pressure inside of their body they feel and struggle to find relief from, that they need heavy pressure. They want pressure to match pain.
Therapists commonly apply pressure to meet client expectations. This is when deep pressure and pain management collide and the outcome is more pain.
At the heart of the expectation, what the client is really asking for is deep change. If we only match their pressure expectation, clients can leave our office in pain that escalates over the next 24 to 72 hours.
I know this because I have felt this in my own body from deep tissue treatments. I also asked my clients how they did and to be honest with me. They experienced a similar reaction. Repetition has taught me that the outcome was not what we wanted.
Concept #3: Frequency is the Real Key to Advanced Pain Management
Experience, success and failure taught me that consistency and frequency were the ultimate massage tools of pain-management massage therapy. This is when I started using a pain scale to validate treatment effectiveness.
This scale taught me to repeat what worked and not repeat what didn’t work and design a massage session specific to the client and their pain. It also taught both the client and I how often to repeat treatment to create positive change.
If you were able to reduce pain in one treatment from a pain Level of 8 to a pain level of 4 you have two things happen. Validation of treatment and the client has less pain allowing for the energy to heal.
If a client comes back before reaching a pain level of 8 again, then you are one step ahead of their cycle of pain. If the client returns for treatment at a pain level of 7 and massage can shift pain to a level of 3 then there is change occurring to the pain cycle itself. And again when the client returns at a pain level of 6 reducing to a pain level of 2.
This is why I teach others to employ a pain scale. There is no other pain management gauge as efficient as the pain scale when it comes to gaining insight into treatment effectiveness.
Typically, the massage work ends up being repeated for each session—but when combined with frequency, pain and inflammation begin to reside and that is when pain management massage therapy is given the opportunity to work its magic. This is when you meet the clients expectations of pain reduction.
I spent years trying to adapt technique to produces a desired result. It was only when I changed the frequency of treatment that the success both my client and I were seeking began to happen.
Concept #4: Advanced Pain Management Is About Commitment
While it takes training, technique, practice and skill to become effective with the tools of pain management massage, I can also tell you that is equally just as much about the commitment of both the therapist and the client in a joint effort toward health.
I have a rule for when I accept a new client. They must agree to weekly appointments until their body says that schedule can change.
Sometimes, the hardest part of being a pain-management massage therapist is not about their commitment to me. It’s about fulfilling my commitment to them.
If I am making clients commit to a weekly appointment with me, then I also commit to making that treatment happen. I diligently work to stay ahead of my schedule and appointments for these clients and I do not take on more than my schedule will permit. Boundaries are essential to longevity in this career.
There are many facets to expectation and effective pain management, and I think you can now see what I meant by understanding the difference between pain-management massage and massage therapy. Pain management is so much more than technique and requires a much deeper approach to client education and communication.
Pain is and always will require a willingness to create a very personalized approach for those seeking relief from it and a commitment from both parties to see it through. My hope is that what I offered here can help you in your approach to being a more effective pain-management massage therapist.
About the Author
Amy Bradley Radford, LMT, BCTMB, has been a massage therapist and educator for more than 25 years. She is the owner of Massage Business Methods and the developer of PPS (Pain Patterns and Solutions) Seminars CE courses and an NCBTMB Approved CE Provider.