Chronic pain is one of the most common musculoskeletal ailments, plaguing an enormous portion of the population.
According to the US Centers for Disease Control and Prevention, in a report released in late 2018, about 50 million U.S. adults, or 16 percent of the adult population, experience chronic pain.
As pain science has progressed, so has our approach to assessing and treating chronic pain.
Thankfully, taking an overall approach is becoming more the norm rather than the exception these days. A merger of bio-psycho-social and manual therapies enables us to build treatment plans that can create a positive systemic change with less-aggressive, more holistic methods and longer-lasting results.
Touch that Removes the Threat of Pain
One can make numerous observations regarding the physical presentation of the issue, but gaining an understanding of how the client relates to their pain is equally as important.
While movement assessment provides the kinetic clues, the emotional and neurological weight of the pain can have a profound effect on our client’s perception of their ability to move, their access to certain ranges of motion, adoption of guarded movement patterns, and even internal opinions on their ability to heal at all.
More often than not, successful treatment starts by first removing the perceived threat of danger and pain.
Before a nervous system is receptive to making changes in tissue tone and pattern of movement, it has to feel safe to do so. A number of gentle and novel methods can be used to achieve this.
A touch that relaxes the nervous system such as light feathering and effleurage, the application of analgesic at the site of pain in the beginning of the session, heat, ice, light IASTM, kinesiology tape and even using cups as neurological cueing and gamification have the potential to reduce the tension in a guarded presentation.
These methods open the doors for treatments such as correcting a breathing pattern, restoring stability and addressing postural dysfunction that contribute to the chronic pain. These methods also give the client access to potentially pain-free ranges of motion and activities that they had previously been avoiding.
The psychological impact of restoring movement without pain has a direct impact on the client’s sense of well-being, their sympathetic nervous system, and their motor control center’s ability to learn and adapt new movement patterns.
Areas of chronic pain will often have decreased proprioception and sensory awareness.
Think of it like the GPS in your car. If the GPS can’t find a destination, it certainly can’t tell you how to drive there. This loss of accuracy and awareness is known as brain smudging.
Using simple two-point discrimination methods — whereby the client is asked if they can perceive two points of stimuli presented simultaneously — can establish the client’s margins of cortical mapping and direct your focus of treatment area for re-establishing the neural connections.
Once those connections are made, we again have an open neurological doorway through which we can positively impact the sensation of pain, proprioception, and ultimately, movement.
When it comes to assessing movement, it’s important to incorporate what’s meaningful to the client.
For example, if a client presents with pain during a particular yoga pose, assessing that movement is both relevant and powerful for gaining buy-in. Utilizing additional assessment methods is at your clinical discretion and the treatment plan should include things that directly correlate with the client’s goal of restoring and even bettering the meaningful movement.
Combining manual and movement therapy off the table can have dynamic effects that some static interventions may lack. Using a graded exposure approach for these progressions is key.
For example, taking a client from a passive, supine range of motion in the hip to an open-chain, active movement pattern while you’re applying treatment, then to a closed chain progression in which ranges of motion are increased according to pain-free abilities, would be an example of graded exposure.
Treatment during all of these examples could include manual therapy, cupping, flossing, IASTM or visual cueing.
Go Beyond the Table
As we understand the science of how pain dictates movement, behavior and even impacts our social environments, it becomes even more important for us to broaden our lens and methods of practice.
Learning a holistic model of assessment and treatment methods that go beyond the table benefits the client — as well as the massage therapist.
About the Author:
Stacey Thomas, LMT, SFMA, FMS, NKT, ART, CF-L2, has been a movement specialist since 1997, and licensed as a sports massage therapist since 2005. You can usually find her teaching a RockTapeclass, speaking at national massage conventions or camping with her dog, Charlie.