Pain—and pain management—is something of a mystery.
On a superficial level, it seems obvious that pain is a response to tissue damage, such as a papercut or broken arm. Once the injuries are treated, the pain should disappear, and everything should return to normal.
The problem with this line of thinking is that when you start to probe a little deeper, things become murky, leading to more and more questions that we don’t yet have answers to.
The Mysteries of Pain
Phantom pain has stumped physicians for a long time. Why is it that individuals who’ve had an amputation can still feel intense pain in a limb that no longer exists? After all, the pain receptors in the limb are now gone, so shouldn’t the sensations subside?
Equally strange, research now suggests that low back pain increases after an early MRI, meaning that patients get worse once they see that something is wrong.
Interestingly, some individuals don’t even have back pain at all until they receive the MRI, showing they have an issue. If pain is simply alerting you to an injury, why do the sensations increase if nothing has physically changed?
Even the expectation of pain seems to make the sensation more intense than it originally would have been. It’s as though our brains are making the situation worse than it needs to be.
These are just a few examples of the mysteries facing pain researchers today. Progress continues to be made, but there is still a long way to go.
Now that we see that pain science isn’t so simple, what role can massage therapy play when it comes to pain management?
The answer may surprise you.
Perception vs. Reality
When it comes to pain, things aren’t exactly as they seem.
Pain researcher Lorimer Moseley, PhD, states in a 2007 paper that as pain persists over time, both pain receptors and the brain itself become overly sensitized, making the injury seem more painful than it originally was, even if it didn’t get worse.
It’s almost as if the body is becoming more obnoxious in its attempt to get your attention.
As a massage therapist, this should make complete sense.
As clients guard and protect their injuries, the surrounding tissue tightens up, and the pain intensifies. There are times where the bodywork isn’t deep at all, yet the clients nearly jump off the table in pain.
It’s not that the light pressure did any damage, it’s that the body has become overly sensitized to prevent further injury.
The client is perceiving a worse injury than they truly have, and it’s this perception that could be hindering their recovery process.
Now, this doesn’t mean we should be telling our clientele to “toughen up” or that it’s “all in their head.”
It also doesn’t mean that we should be assuming their pain isn’t relevant to their actual injury — the pain they feel is real, even if the issue isn’t as bad as it seems. Worsening the injury due to your negligence doesn’t help anything.
We should be coaching our clients on the importance of gradual improvements by pushing cautiously through painful sensations.
As massage therapists, we can guide them through this process in a session, breaking up scar tissue and slowly bringing back movement.
Movement is the key here. Without it, there can be no recovery.
Movement = Health
As anyone who has spent time in a hospital bed can tell you, the sooner you’re able to start walking around, the better the healing process is going.
There’s a reason why the hospital staff wants you to get out of your bed and move around — movement lessens scar tissue development, increases blood flow, and speeds up the healing process.
Obviously too much movement performed too quickly can be a bad thing, but in the right amount with a proper speed it can work wonders.
As a massage therapist, we have the capability to move our clients through passive stretching and range of motion during our sessions.
Through repatterning exercises, we can coach our clients through the process of moving with pain in order to retrain the nervous system to not send an unnecessary pain signal.
Remember, the client’s perception of the injury is worse than the actual reality. There’s wiggle room when it comes moving without making things worse, and this is what they need to aim for.
Clients need to be coached on how to listen to their body, slightly push past their comfort zone, but never push harder than they need to.
Massage as a Piece of the Pain Management Puzzle
As researchers continue to unravel the mysteries of pain, treatments will evolve, becoming more specific to the pathology, and less dependent upon broad ranging medications that have dire long-term consequences.
With evidence showing that pain is a multivariable problem, massage therapy is in the perfect position to play an integral role in its treatment.
Massage therapy has already been shown to be effective in the management of both acute and chronic pain, but studies also show that the effects are short lived, usually lasting up to a month or so.
Rather than be discouraged by this, we need to embrace it. We as massage therapists need to realize that our profession isn’t the singular answer to pain management. Instead, we are an incredibly important piece to an extremely complicated puzzle that still has a long way to go before being completed.
Massage therapy can literally change a client’s perception of pain. By increasing movement in joints and muscle tissue, bodywork can accelerate the healing process and increase the quality of life.
This by itself is immensely powerful, but when it’s added to meaningful and precise surgeries, quality physical therapy, well developed nutritional plans, and strong mental and emotional support, our clients have the best chance of eliminating chronic pain.
About the Author:
Justin Cottle, LMT, teaches Anatomy, Physiology, and Pathology for the Cortiva Institute at the Utah College of Massage Therapy, as well as instructs future EMTs, medical assistants, dental Assistants, Estheticians, Massage Therapists, Structural Integrators, and Yoga Instructors at the Institute of Human Anatomy. He wrote “None of Us Have Any Idea What Trigger Points Really Are” for massagemag.com.