Pain relief

Recently an older, somewhat frail woman came into my office. She has a serious condition that requires ongoing treatment and the primary condition creates numerous other serious health problems. In spite of this, she maintains a cheerful disposition and endures it all with acceptance.

A dear friend of hers thought that she might like a soothing massage and sent her to me, trusting that my experience and training would allow for both a pleasant and safe experience. The client consulted with her doctor about what would be permissible and what should be avoided and had his consent to have gentle massage.

Besides her complicated and generally frail condition, the client had osteoporosis and had suffered several broken bones as a result. Clearly, this was someone who needed to be handled very gently.

And she had neck pain.

I've been learning a lot about the role of the brain and the central nervous system in our experience of pain. One of the people who studies this and writes about it is Lorimer Moseley, co-author of Explain Pain. His TED Talk explains, in 15 minutes, some important discoveries in pain research.

While low back pain may be one of the most common complaints seen by doctors, neck and upper back/shoulder pain is the most common complaint seen in my office. So many people spend their days sitting in front of a computer, head forward and motionless for hours at a time, it seems inevitable that eventually the neck and upper back are going to begin to  protest. I encourage clients to get up and move as often as possible and especially to move in directions that are different from or opposite to the direction in which they've held themselves for extended periods. The body wants to move and likes variety of movement.

A colleague on a private forum asked the following questions in response to some thoughts I posted yesterday. In particular, he wondered about the description of an experience I had with a client. His question:
 

Having effect on the nervous system by stretching skin will relieve pain?  . . . [Is] Dianna [sic] relieving trigger points in this fashion? Seriously? Sixteen years ago, I never knew what was causing my pain. Doctors didn't know either. And then I ran into a PT who did know and mentored me. Trigger Point work, as I have benefitted, is painful. Paul Ingraham and Amber Davies agree, they hurt like hell when compressed. That "painful work" is the only thing that has ever given me tempory relief. I'm just not seeing where skin work is going to effect a mechanical release of myofascial contraction knots.....

The other day I wrote an article, directed at massage therapists, about massage and lactic acid.  However, for some clients it might be too much information, as they say, and may not answer the client's question, "What does this mean for me?"

Many, many people have heard that lactic acid is produced in the muscles during exercise, makes the muscles sore, and that massage helps get rid of lactic acid. This was once thought to be true. However, it has been discovered that lactic acid is not what makes muscles sore after exercise. What causes post-exercise soreness? We're not exactly sure but current thought is that it may be microscopic tears in the muscle fibers and inflammation.

What does this mean for the client? It may not change very much what we, as massage therapists, do. It changes what we think about what we do. Massage still makes people feel good and it makes muscles feel good. If you have aching muscles, there's a good chance that the right kind of massage can help.

[Please note: a simpler article on this topic, written for clients, can be found here.]

Lactic acid has been blamed for delayed onset muscle soreness (DOMS) for decades. Physiologists once believed this to be true. However, it has been known at least since the 1960s that lactic acid is not responsible for DOMS.

Self-massage is a great self-help technique for common aches. However, sometimes it's hard to reach the places you want to massage or it's difficult to relax while trying to massage yourself. This is where tools can make a great difference.

A reader asks:

Will sitting at a computer all day and leaning to one side cause poor posture and ultimately pain?  Linda 

Absolutely! A large percentage of my clients have postural and pain problems caused or aggravated by sitting in front of the computer for long hours. This bane of modern life can lead to lower back pain, upper back pain, neck pain, shoulder pain, and pain in the arms, including carpal tunnel syndrome (CTS).

Sitting itself can cause poor posture when it is done repeatedly for long hours. When we sit, the curve in our lower back tends to flatten our and this forces the head forward. Head forward posture is a very common problem in our sedentary society. When the head is moved forward, it's tendency is to look down. However, we don't usually want to look at the floor so we tilt the head upward. This creates a state of chronic tension in the muscles at the base of the skull. One way to minimize this problem is to use a small pillow to support and maintain the curve of the low back.

Swedish massage. Deep tissue massage. Sports massage. Russian massage. Trigger point therapy. What are they and how are they different? If you are a client looking for a massage, how do you know what to ask for?

You don't necessarily need to know the name of a specific technique but you do want to be clear about your goal. When a new client walks into my office, I ask them what brought them in and what do they want to get out of their session? Some want to relax. Others have some sort of pain that they'd like to get rid of. Still others want to improve their performance. By understanding the client's goal, I can tailor the session to their specific needs. However, people do frequently ask the question, "What is the difference between these different kinds of massages?"

Massage is an ancient healing art that has been practiced in every culture. Captain Cook once described how his back pain was successfully treated with massage by the native people of Hawaii during his stay in the islands.

Massage has evolved and taken many paths and continues to evolve during these modern times. With so many names and philosophies, how does a client know which is the right kind of massage for them? And how does the therapist know what is the right kind of massage for the client? Sports massage, Swedish massage, Russian massage, acupressure, deep tissue massage . . . there are so many different kinds of massage. I'll discuss some general categories in another article but for now I want to talk specifically about what I mean when I say that the right kind of massage can be very effective, while the wrong kind of massage will, at the very least, be ineffective and, at worst, cause symptoms to worsen.