Ask the Massage Therapist

Many massage therapists are suspect of science. Some reject it outright, believing that somehow it will make massage therapy cold and take the sense of wonder and depth out of it. In fact, when I went to massage school in 1991, many massage therapists objected to learning anatomy and physiology because they thought it would ruin the therapist’s intuition. Today, even the most ardent proponent of energy modalities would probably admit to the need to study anatomy, physiology, pathology, and the science of massage. Still, many cling to the notion that “Western” science somehow debases massage and look to Eastern traditions, pseudoscience, and mysticism as being more “holistic.” To those who think that science robs one’s sense of wonder, I highly recommend the book The Sacred Depths of Nature by Ursula Goodenough.

Ever since I got a website, I see a lot more pregnant women for prenatal massage. I don't know if there's a baby boom happening or if it's just easier for them to find me. I have learned that a lot of massage therapists don't do prenatal massage and many of the franchises will not accept pregnant clients, either. If a therapist has not been trained to do prenatal massage, they should certainly refer out to a therapist who has been trained. However, some of the reasons for turning down pregnant clients are based on unwarranted fear and misinformation.

Many massage therapists report that they have been told not to give massage to a woman during her first trimester. Some have been told that there is a risk that massage may cause a miscarriage. This is an absurd idea and is probably based more on fear of litigation (unfortunately, the U.S. is a very litigious society) than on any actual risk. Most women don't know they are pregnant until they are well into their first trimester. The only way we could completely avoid giving massage to women in their first trimester would be to refuse to massage all women of childbearing age. Certainly no one is advocating that.

People come to my office for a variety of reasons. Some come to relax and that’s great. I think if we all got a massage about once every three weeks, the world would be a kinder, gentler place. People would probably be nicer to each other, to their spouse and their kids, and maybe be a little more patient to the guy who cut them off on the highway without realizing it because his mind was on something else or he didn't see you in his blind spot. Massage for relaxation, to "downregulate the sympathetic nervous system" (tech talk for chill out,) for the pure enjoyment of it, is a fine reason to get massage. 

Others come because they’re athletes or musicians or have other reasons for wanting to keep themselves in top shape. They appreciate having a body that’s well-tuned, not held back by unnecessary tension or bothersome pain.

I see a fair number of pregnant ladies,. It seems a lot of massage therapists don't do prenatal massage. I welcome mothers-to-be. I love nurturing women during this special time of their life and enjoy helping to relieve the temporary discomfort that often accompanies pregnancy.

I was recently contacted by Fiza Mahmood and Toni Kodner of the St. Louis Gateway Area Chapter of the National Multiple Sclerosis Society and asked to speak on a conference call about massage therapy and multiple sclerosis. Although my familiarity with the condition and experience with clients with MS is limited, they thought my expertise with a variety of conditions and efforts to stay informed would be relevant enough, so I agreed and became very excited about this unique opportunity.

I’ve noticed a disturbing and recurring problem among some massage therapists, chiropractors, and other manual therapists: that of citing studies to support a claim which, in fact, do not support it, leaving the impression that either they did not read their citation or, if they did, clearly did not understand it. 

Most of us were brought up, professionally, with an idea of "deep tissue" and the need to "break up adhesions," "stretch fascia," and generally "fix" the meat and bones. Along the way, some of us discovered pain science, neuromatrix theory, and the realization that it is the nervous system that creates tension, creates the sensation of pain, and it is through the nervous system that one corrects it. We came to understand that manual therapy works not by mechanically altering muscle, facia, posture, etc., but by influencing the nervous system.

Modern pain science has found that the more the nervous system is subjected to nociception, the more sensitive it becomes. Therefore, we avoid creating pain.

Many musicians live with chronic or intermittent pain as a result of playing their instrument. Pain is not only an annoying distraction, it can interfere with your playing. Pain inhibits motor activity, which means you have less strength and dexterity. Pain has prematurely ended the careers of many professional musicians.

In this class, we'll be exploring ways in which musicians can help themselves to avoid, reduce, and minimize pain and stiffness. We'll practice movements for the neck, forearms, and shoulders. We'll explore using graded exposure and micro-movements. We'll talk a little about how pain works and how that knowledge can be used to combat pain.

Although this class will focus on the common problems experienced by musicians, you don't have to be a musician to take this class. If you work with your hands, sit at a computer all day, or generally like to learn how to care of yourself, this class is for you, too.

About a week ago I put up a pain questionnaire.  


As promised, we're providing the answers, courtesy of Zac Cupples, PT.

Zac 
Cupples, a physical therapist in Plainfield, IL, had such great answers to these 
questions that I asked him if I could borrow them and he agreed. A few sentences were edited out for brevity and to keep it where we non-PT folks can understand. Read his unedited answers and the rest of his article on pain education here. Also highly recommended is his series on the book Explain Pain. If you haven't read it, this is a great chapter-by-chapter summary. If you have, it's a great review.

Thanks, Zac! 

And now for the answers:

“The best way to treat chronic pain is to prevent it.”

Pain receptors convey the pain message to your brain: FALSE

How well do you understand how pain works? Answer these questions and find out. We'll publish the answers after the pain education class this Saturday.

Pain Neuroscience Questionnaire

True or False?

1 When part of your body is injured, special pain receptors convey the pain message to your brain.

2 Pain only occurs when you are injured.

3 The timing and intensity of pain matches the timing and number of signals in danger messages.

4 Nerves have to connect a body part to the brain in order for that part to be in pain.

5 In chronic pain, the central nervous system becomes more sensitive to danger messages from tissues.

6 The body tells the brain when it is in pain.

7 The brain can send messages down your spinal cord that can increase the danger messages going up the spinal cord.

8 Nerves can adapt by increasing their resting level of excitement.

9 Chronic pain means an injury hasn’t healed properly.

10 Receptors on nerves work by opening ion channels (sensors) in the wall of the nerve

Chronic pain is epidemic. It is estimated that 25% of American adults live with chronic pain and the costs in terms of medical expense and lost productivity run into billions of dollars every year. It is impossible to calculate the cost in terms effect on the quality of so many people's lives. 

We are excited to be offering a two hour pain education class at Forest Park Community College on Saturday, April 12, 2014. The class, Explaining Pain: Help Manage Chronic Pain, is for anyone who lives with chronic pain, anyone who lives or works with individuals with chronic pain, or anyone who wants to better understand chronic pain. Professionals, non-professionals, people with pain or people without pain are all welcome.

This two hour lecture will introduce you to what modern pain science has learned about chronic pain and ways that may help you manage it more effectively. The class will be based on the book Explain Pain by Butler and Moseley.