Neuroscience

A 38 year old woman suffers permanent shoulder drop after a "deep tissue" massage caused damage to a spinal accessory nerve.

A 59 year old man suffers a deep hematoma, numbness, and swelling after being injured by a deep tissue massage to his hip.

A client tells a massage therapist that he wants more pressure. She complies. He again asks for more pressure. She complies. He again asks for more pressure. Unable to exert any more pressure with her hands, she resorts to using a hand-held tool to apply more pressure without hurting her joints. Shortly after, she receives an email from her employer that the client is suing their business, claiming that he was injured by the massage.

Last Sunday, three St. Louis area massage therapists met to watch a video recording of Peter O'Sullivan's keynote address at the 2017 San Diego Pain Summit. The subject of O'Sullivan's address was A Paradigm Shift in Understanding and Managing Low Back Pain.

"How does massage work?"

My late Russian Massage teacher Zhenya Kurashova Wine asked this question at the beginning of my first class with her. We sat and looked at her blankly. No one raised their hand, no one offered an answer. What kind of a question was this, anyway? We never thought about this. You know, you put your hands on people and then . . . well, massage happens!

When it became apparent that no one was going to attempt to answer, Zhenya finally said, "I'll tell you how it works," and then went on to explain.

Christopher Moyer, Ph.D., is a psychologist who has done research in massage therapy and meditation. He recently began a blog on research and massage therapy and I was honored that he asked to interview me for his blog.

I first got to know Chris when I heard that he’d done a metaanalysis that overturned what a lot of us thought about massage lowering cortisol. Curious, I looked him up on the internet and sent an email asking about his paper. Shortly after, I encountered him again in online discussions and it led to a friendship that was both professional and personal as we discovered we had many common interests.

In late February I went to the first San Diego Pain Summit: Clinical Applications of Pain Science for Manual Therapists conference. Professionally, it was as if I’d died and gone to heaven. It was off the scale amazing.

When Rajam Roose, who deserves the highest praise possible, first announced the event, I decided immediately to do whatever it would take to be there. First, there was the keynote speaker. I have been a fan of Lorimer Moseley, who I describe as a “pain science missionary,” for quite some time, and when I heard that he would be the keynote speaker, I could not pass up an opportunity to hear him in person. Brilliant, funny, personable, and an engaging storyteller, he makes learning pain science fun and painless. I've referred countless clients and massage therapists to his videos and no way would I miss him!

The labeling of nociceptors as pain fibers was not an admirable simplification, but an unfortunate trivialization under the guise of simplification. 

From Patrick Wall, eminent pain scientist and author of the gate theory of pain.

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.

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.

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.