Whitney Lowe, LMT, directs the Academy of Clinical Massage, through which he offers continuing education and advanced clinical massage.
He also offers an online training program in orthopedic massage, and he authored the books, Orthopedic Assessment and Massage Therapy and Orthopedic Massage Theory and Technique.
Whitney is also a MASSAGE Magazine All Star, one of a group of body-therapy masters who have dedicated their lives to empowering and informing massage professionals.
These innovative therapists and teachers are lined up to educate the magazine’s community of massage therapists in our print magazine, on our social media channels and on massagemag.com.
Karen Menehan: Whitney Lowe, let’s start with you telling us why you think it’s important massage therapists to understand current research on pain.
WL: Well, this is what’s frequently referred to as pain science, and it’s really influencing a lot of different healthcare professions, mainly because our understanding of the physiology of pain has changed and evolved.
As a result of that, many treatment approaches for addressing pain problems also are sort of modifying and changing to accommodate and work in conjunction with what is our more current research understanding.
Certainly, anybody who’s been paying attention to the news recently in the last couple of years knows that we have a very serious medical crisis in this country with the opioid epidemic—and there’s a great deal of interest in looking at various pain-management strategies that don’t involve the potential for pharmacological interventions and addictions.
KM: What are some results of that exploration?
WL: We’re recognizing that interventions such as massage are incredibly powerful and impactful in addressing a lot of pain problems, because they address issues with people on a variety of different levels.
In particular, not only what we’re doing with biologically based tissue approaches, but also the psychological and social aspects of what happens during a massage intervention.
There’s just a lot of therapeutic power in that long relationship that we have with a client for the hour that we’re with them in a very relaxing, calming and soothing environment. So we’re recognizing now that it’s a lot more than just simple biology of trying to stop somebody’s pain in the tissues of their body.
It’s a much more complex process, and massage can play a really significant role in that.
KM: Are researchers understanding the relaxation benefits of massage therapy and looking past all the technique names?
WL: I think we’re definitely moving in that direction, it’s something that’s being grappled with, not only in our profession but also a great deal in the physical therapy profession as well.
We’re recognizing now, through research, that a lot of it is not so much about a particular technique and exactly what you think is happening or that you think you’re doing to someone.
A lot more of the power and benefit in many pain-management strategies is simply about a very positive therapeutic intervention with people, giving them positive and comforting touch, and working with the brain and the nervous system at that level to help reduce pain.
It’s not as important, as we used to once think, exactly what you do. It’s actually more important how you do it and how you interact with the individuals that you’re working with.
KM: So you just mentioned the nervous system and the brain’s role in our experience of pain. Can you talk more about what current pain science is revealing in that regard?
WL: Formerly our understanding of pain predominately had a model in which pain was generated at the periphery of the body.
Let’s say you bang your hand with a hammer, there was an idea that you are then sending a pain signal up through the nerves to the brain and it is somehow further processed at that point.
[But with] phantom limb pain, why does somebody’s leg hurt if that leg is no longer there? That doesn’t fit in the model of this pain moving from the periphery back to the brain.
Now what we actually recognize is that we see pain is essentially an alarm system in the body that can get set off by numerous receptors in the exterior of the body.
So when your hand gets hit by that hammer, it’s basically sending a signal back up to your brain just as we thought it did previously,
But the pain sensation isn’t created until it gets to the brain and is then modified and sort of worked in conjunction with all kinds of other physiological factors—memories, experiences, social phenomenon, psychological concerns, stresses, biochemical changes—all kinds of factors play into whether or not that will actually turn into what we perceive as a pain sensation.
This is leading us into an understanding that the brain is far more involved with the process of generating a pain signal, [beyond] what happens at the periphery of our body.
KM: What does all of this mean for a massage therapist? Is there a way that people can extrapolate this information to their practices or in informing their clients about the benefits of massage therapy and other types of bodywork?
WL: There’s a couple of different strategies that I encourage massage therapists to look at. First off is, you don’t really need to change a lot of what you’re doing if what you’re doing is working, because what we’re now understanding is it’s not really so much about, “We need to do things a whole lot differently.”
What a lot of the new pain science really shows us is that what we thought we were doing may not be the reason why it works. This is actually important in some of the narratives that we tell people. There are ways in which it’s a good idea to change or to think about how it might change the way you work in the clinic treatment room.
Let me just give an example to illustrate. Frequently, I will hear massage therapists make comments that they would say to a client, like, “Wow, man, you’ve got really tight traps. We need to do some work on this.”
Well, in that one brief little sentence you said to that person, you’ve planted a thought in their mind, “Oh, wow, my traps are really tight, something’s wrong with me, I need to do something about this.”
And we’ve now recognized through a lot of the pain research that thought processes about [pain] can play a role in whether or not that perpetuates a pain problem.
So somebody gets told that their shoulders are uneven, or their pelvis is tilted, or their foot alignment is out.
All of those things can spin into a complex process of things that produce or perpetuate pain problems for people. So the way you talk to your clients in the midst of the work you’re doing is really important.
This is one of the things that I think we’re learning a lot about this whole process, that the things that come up in the conversations that we have with our clients can have a major role in either increasing or decreasing the potential pain sensations that they may feel.
KM: I know that you’ve long been a proponent of engaging in in-depth assessment prior to a session, so if you’re assessing a client and you see that the left shoulder is 2 inches higher than the right, how would you communicate that in a way that doesn’t accentuate pain perception?
WL: That becomes a really interesting process to look at. It has actually changed the way I have looked at assessment a great deal.
What we’re now recognizing is that there are many things that we have turned into pathological problems or pathologies, like raised shoulder, or forward head posture, or anterior pelvic tilt and they may not really be pathological.
And let’s say a person has shoulder pain, neck pain or low-back pain. We said, “Oh, you’ve got back pain because you’ve got an anterior pelvic tilt” or “You’ve got head and neck pain because your shoulder is higher.”
But when we actually look at the research of these biomechanical problems, what we’ve recognized is that in many instances lots of people have these things and don’t have any problems whatsoever.
So we have to be careful when we’re going through the assessment process not to turn something that we see into a pathology.
That’s one of the reasons that I harp on assessment so strongly. Assessment is a whole lot more than just looking at people, it’s a whole lot more than just, asking a couple of questions.
It’s a comprehensive process to recognize, “OK, maybe there’s a structural or biomechanical alteration that’s present. But is it relevant?” That’s the question that we want to ask.
Let’s say a person has a leg length discrepancy. Maybe that’s not relevant if they just go through their daily life and are, having a good time doing things.
But then all of a sudden, they decide, “Hey, I want to start a running regimen. And they start running 15 miles a week or something like that.
Now, all of a sudden that leg-length discrepancy may turn into something that could become a potential pain problem for them.
So the assessment process becomes even more important to recognize when things are contributing to a problem or when are they just incidental findings that happen to be present in lots of people.
KM: Thanks, Whitney.
Karen Menehan is MASSAGE Magazine’s Editor in Chief.