Pain relief

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.

My friend recently died of breast cancer. She was an amazing woman who lived fully until the end. Everyone who knew her loved her, she made everyone feel special. I hadn't known her all that long or even that well but she had an impact on my life out of proportion to our time spent together. When her cancer recurred, I wanted to do whatever I could to help. One of the things I was able to offer was massage.

Our first massage was a general full body relaxation massage. She loved it. She had been having trouble sleeping and it left her feeling so relaxed that she felt as if she could fall asleep. I told her I would come and give her massage whenever she wanted. She stayed pretty busy in spite of the illness and so several weeks passed before I gave her massage again.

"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.

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.

Clients never mention it, but occasionally in more personal conversations someone will bring it up: chronic pain can interfere with intimate relationships.

Most clients would not mention it to their massage therapist and it is not within our scope of practice to treat. However, since February is the month of Valentine's Day, I thought it would be an appropriate time to bring up a pain topic that may hurt your love, is rarely discussed, that many massage therapists may not know exists, and that many people may suffer with silently without seeking help or getting proper treatment.

Common chronic pain problems can hurt your love.

Chronic low back pain and chronic headaches are two common pain problems that can interfere in intimate relationships. It's hard to feel romantic when your head hurts and low back pain may make physical intimacy difficult. When chronic pain interferes with your love life, it can erode the closeness of your relationship. This is just one of many reasons why chronic pain should be treated and not just assumed to be an inevitable part of life. The deterioration of the quality of one's life can be far-reaching.

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.

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