Inflammation is something we as massage therapists witness daily in the clients on our tables.
In a sad way, inflammation creates job stability for massage therapists, because inflammation oftentimes results in pain; accompanies arthritis and other conditions; and is growing in prevalence.
Inflammation is also an aspect of diabetes, inflammatory bowel disease, obesity, heart disease and vascular dementia, which can make effective massage treatment and outcome difficult.
According to researchers C.R. Green and L.F. Nicholson, “a number of chronic diseases, including neurodegenerative, cardiovascular and metabolic disorders, are associated with genetic susceptibility. Some may originate on exposure to an environmental stimulus. Regardless of genetic predisposition or external stimulus, these chronic diseases, once triggered, share an inflammatory component making them effectively persistent ‘wounds.’
“There is also increasing evidence that the presence of one disease can cause activation of another apparently unrelated disease, leading to multiple disorders via activation of an immune response that ‘fast forwards’ disease progression,” they added. (“Interrupting the inflammatory cycle in chronic diseases–do gap junctions provide the answer?” Cell Biology International, 2008.)
However, I think the real question in your mind is probably not “What is inflammation?” I believe what more therapists want to understand is why some people heal from inflammation while others do not. And, of course, how a massage therapist can facilitate that healing outcome.
I believe a two-part understanding of how massage affects inflammation and which massage approach can help is best.
Acute and Chronic Phases
Each person is biologically programmed to heal. Our bodies have an amazing method to heal themselves from just about anything, and that process is called inflammation.
This process has a governor—the immune system, which supplies the necessary, raw materials to start, work through the pre-organized steps, and finish the inflammatory process.
The involvement of the immune system helps you understand why those with autoimmune issues have inflammatory system issues, from overactive inflammation, to inflammation failure.
There is a three-month healing phase for acute healing and a phase that can last up to two years—or more—for chronic phase inflammation, according to many sources.
The chronic phase, and why it takes so long for some clients to finish it, is what I would like to talk about.
There is more to inflammation than just the period of time that you see the classic signs of redness, pain, swelling and heat. Those presentations exist during the acute phase—and this phase is about damage control; pain control; cleanup; large-scale remodeling and rebuilding of tissue, or scar tissue replacement; bacterial or viral control; and security and welfare of the tissue and body as an organism. There is a tremendous amount of energy allocated to this intense, 12-week process.
Chronic phase inflammation is really about detailed repair, long-term strength of a tissue, ability to withstand wear and tear, functionality, mobility, bacterial or viral control, and many other functions that occur once the body knows it is out of danger.
The energy allocated to the chronic process is much less than what is allocated during the acute process. The body is out of danger. Continued tissue remodeling and healing at this point must be integrated into the multitude of bodily functions of daily life.
When Good Inflammation Becomes Bad
There is much study today on the harmful effects of long-term chronic inflammation. As mentioned, there can be an increase in heart disease, joint disease, immune system issues and many other deteriorating factors that come from the body always being in a chronic state of inflammation.
The inflammatory process becomes harmful to the body when the chronic phase never finishes its remodeling phase. Re-injury occurs, causing inflammation to return to the acute phase, starting the process over again, according to many sources.
The inflammatory system was never meant to be turned on to that degree all the time. A few of the factors that force the body to maintain this constant setting are:
1. More injury occurs to the tissue. This can be damage from overuse, not enough time to heal an area before using it again, reinfection from bacterial or viral invasion, or autoimmune components.
2. Medications that repeatedly stop certain chemical reactions from completing their processes in the chronic phase of healing, such as overuse of anti-inflammatory medication.
3. Unresolved pain. Pain plays a huge factor in how inflammation turns on and off. (See the section titled “Inflammation, pain and massage,” page 45.)
The Connection Between Inflammation and Energy Depletion
There will always be one common denominator with the chronic inflammation process, in my professional opinion: There is just not enough available energy to finish the job.
Energy is a lot like money. We all have certain bills that come due every month. Typically, you plan and budget for those expenditures, allowing yourself a certain amount of spending cash. If you handle your money responsibly, you also have a savings account that you regularly contribute to for unforeseen future needs or special events.
When the day comes that you need money for a car repair or medical bill, you have it available so that it does not have an impact on your monthly budget. You have set aside the necessary surplus to cover your needs.
If you don’t have a savings account, you still have to pay the additional expense to fix your car, and that directly impacts your monthly budget. The typical scenario outcomes are that something gets a partial payment, put off until next month, or not paid at all. You get behind because there wasn’t enough money to pay for everything.
We have all been there. We do our best to spread out the effects of not having enough money across the board, trying to put a little bit toward everything so that we remain in good standing with our credit. However, the total required amount cannot be paid at that time. We just hope that sometime in the future we can catch up—or we have to find more money to catch up.
Our bodies do exactly the same thing; just replace the word money with energy.
When there isn’t enough energy to cover everything we need to do, then the body starts allocating partial energy disbursements to different functions. Yes, the liver is running—but not cleansing as well as it should. The muscles are moving—but pain-reduction chemical production is lowered or depleted, and you have more muscle stiffness and achiness. Chronic inflammation is still healing an area—but its processes are slowed, prolonging the completion of the remodeling phase, creating a weaker area that is set up for injury again in the future, according to Maureen A. Hardy, author of “The Biology of Scar Formation,” published in Physical Therapy in 1989.
If you have several areas of chronic inflammation occurring at the same time, severe energy depletion occurs and the body is unable to finish the healing process. Breakdown occurs, the acute phase of inflammation restarts, and more energy is required again. This is when we start to see the disease process begin.
Inflammation, Pain and Massage
In the last 20 years, I have learned that one of the greatest contributors to creating an energy surplus is pain reduction. I have a favorite saying that simplifies how we affect the inflammation process with massage: “The body can either fight pain or heal. It does not do both, at the same time, very well.”
As a massage therapist, you have the ability to use your hands to directly affect pain, and, therefore, energy. I believe that is the essence of how massage creates the opportunity for natural healing.
Massage can therefore be seen basically as debt management. It can be like someone stepping in to help you figure out how to spend more wisely or finding a way to make more money to pay more off. Whichever way you look at it, healing is a process that requires you to get yourself out of energy debt before it can occur.
Massage creates many small changes that, when you add them together, have a total overall effect on the amount of available energy the body can use to heal itself.
It isn’t so much that massage heals the body; it is that massage can free up displaced energy expenditures so that the body then has the required surplus of energy it needs to heal itself.
In a general massage session, a client’s body can experience several of the following:
• A drop in heart rate.
• A drop in the rate of nerve impulses.
• A decrease in the amount of perceived stress—with a correlating drop in pain perceived.
• A direct impact on an area of pain—physically, mentally and emotionally. You feel taken care of; your pain has been touched and validated; relief is given; you have helped yourself.
• A change in hormone—including cortisol—output that soothes and calms the body.
• Improved and increased digestion.
These effects of massage therapy compound when added together to create an energy surplus that the body then uses to heal itself. The more pain, inflammation and healing required, the more repetition is suggested to help the body naturally.
This is one of the reasons why fibromyalgia sufferers do better with frequent, short massage sessions. These clients have much energy debt occurring, and the more times massage can create an energy surplus for the body, the closer the client can get to finding a way to manage his or her pain.
Massage and Stress Relief
A couple of years ago, researchers determined that chronic psychological stress is related to the body “losing its ability to regulate the inflammatory response.”
As we know, massage therapy relieves stress by helping activate the relaxation response; inspiring the release of oxytocin; and simply giving clients the opportunity to tune out and relax.
A research team led by Carnegie Mellon University’s Sheldon Cohen, Ph.D., summarized: “Stress wreaks havoc on the mind and body. Until now, it has not been clear exactly how stress influences disease and health. Now researchers have found that chronic psychological stress is associated with the body losing its ability to regulate the inflammatory response.”
According to a Carnegie Mellon press release, “Cohen argued that prolonged stress alters the effectiveness of cortisol to regulate the inflammatory response because it decreases tissue sensitivity to the hormone. Specifically, immune cells become insensitive to cortisol’s regulatory effect. In turn, runaway inflammation is thought to promote the development and progression of many diseases.
“‘When under stress, cells of the immune system are unable to respond to hormonal control, and consequently, produce levels of inflammation that promote disease,’ Cohen said. ‘Because inflammation plays a role in many diseases such as cardiovascular, asthma and autoimmune disorders, this model suggests why stress impacts them as well.’”
He added, “Knowing this is important for identifying which diseases may be influenced by stress and for preventing disease in chronically stressed people.”
Pressure, Time and Techniques
My next favorite saying about massage in general is, “You can give and take away at the same time.”
What this means is that you must be selective as a therapist with what type of bodywork you apply to each client based on the different levels of inflammation and energy depletion.
Realize that therapeutic inflammation, or aggressive pressure techniques, for people who are exhausted and in pain will typically result in more inflammation, pain and exhaustion. You are giving them energy through the basic application of massage, but also creating more inflammation, which requires energy to heal.
At the end of the session, the massage given to the body created healing energy but forced it to allocate it to another area by creating acute inflammation in a muscle. Being able to create a positive change in the body, and chronic inflammation, requires using the appropriate pressure, time and techniques for a healing outcome to occur.
Sometimes, for massage to be effective in pain management, its application needs to be different from what some massage therapists might believe is correct. It may not be about applying more pressure, creating more inflammation, and energy debt. It can be simple and basic—which brings me to my last favorite saying, “create the healing energy for the body and then let it heal itself.”
Amy Bradley Radford, L.M.T., B.C.T.M.B., has been a massage therapist and educator for more than 20 years. She is the owner and developer of Pain Patterns and Solutions Seminars CE courses. She has authored several books, including Defining Expectations for Massage Therapists. She wrote “Better Barter: How to Create Positive Trades” for MASSAGE Magazine (May 2016) and “At the Table, Always Be Polite” for massagemag.com (June 1).