Issue link: https://www.massageandbodyworkdigital.com/i/969285
A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 73 This process is descending modulation (or descending inhibition). Applying soothing and comforting touch during treatment enhances the process of descending modulation and is one of the most powerful effects of massage for pain management. There is a tremendous amount of neurological input to the central nervous system from the skin. Gentle massage approaches, such as those described as myofascial release, or dermoneuromodulation, can be helpful in acute and severe pain situations where the nervous system activity is ramped up. Knowledge of relevant nerve anatomy and which neural structures might be irritated in a particular region are important in guiding these applications. STRUCTURAL AND PAIN One area of massage treatment that might be adapted to meet new pain science ideas involves structural or postural components. The biopsychosocial model of pain strives to look more at the whole person as a system and not place so much emphasis on mechanics and structure. There are treatment approaches and modalities in massage therapy that still keep biomechanical and structural models as the foundation of their treatment approach. What's most important to recognize is that the uniqueness of a person's pain experience means that any one particular issue (swayback for example) is not always the cause of that person's (in this case, low-back) pain. Simply because there are notable postural "alignment" issues, does not mean they are the cause of the client's pain. Postural or structural factors have to be looked at in context. Take the common forward-head posture (FHP) during texting, pathologized now as "text neck." We know from biomechanical studies that large numbers of people have FHP and no pain. So, is FHP irrelevant for back or neck pain? No, it isn't— be sure to note it in your assessment. However, a single static postural position is not sufficient to determine that pain will be felt. If that person moves around a good deal, there may be no problem at all. If, however, that position is held for long periods of time, the position is now compounded with time and load as factors that can overwhelm the tissues. Similarly, just because back pain exists along with a leg length discrepancy does not mean the length difference has caused the pain. In fact, most people have some degree of discrepancy. However, if the client history shows the individual recently began a vigorous running regimen, that postural aberration is now compounded with repetitive loading, which makes it a far more likely component of the existing pain complaint. In both situations, skilled assessment and clinical reasoning are critical for determining when various factors are a key part of an existing pain complaint. IN SUM Current pain science research offers fascinating new ways to understand how pain functions. However, if there is a takeaway about what not to do, it is this: do not try to turn your clients into neuroscientists by overloading them with complex neuroscience principles. The most misunderstood concept in pain science is the idea that pain is an output of the brain. This concept is sometimes interpreted as pain being "all in a person's head" and therefore less real. And sadly, this is sometimes still told to people who have idiopathic pain by other health-care professionals. Limit your consults about pain to factual tidbits that are consoling, not negating. Massage therapists remain a frontline health-care profession, where a person's pain may be validated. We do not want to misinform our clients on complex pain science concepts or risk accidently making their pain sound like something unreal ("pain originates in the brain"). We can console clients by letting them know that pain is complex, and that different treatments might be warranted to relieve other aspects of their experience. We should strive whenever possible to offer treatments that don't cause more pain. The concept of "no pain, no gain" simply doesn't work in this context. Perhaps more gentle and superficial work is provided for heightened neurological activity instead of deep and specific work, for example. It has been shown that clients benefit from learning about pain. However, effective communication is key. Simple pain science concepts can be dripped into conversations in a limited way. For example, a client with anxiety over a diagnosis of degenerative disk disease can be consoled with the fact that people can have significant disk degeneration without any pain. Similarly, those in chronic pain might be informed that pain can be made worse by being overly protective in their movements. However, this kind of advice can only come after thorough assessment and a solid clinical history with the client. Dropping factoids on clients without proper context or substantial investigation of the client's issues and treatment history can lead to bungled messaging and may actually be detrimental to progress. In the end, we are massage therapists. The care we provide cannot be attained elsewhere for our clients. Always look before you leap. And remember, science and research are evolutionary processes that guide us. Rarely do they provide absolute black-and-white answers for clinical reality that are the same for every person. Whitney Lowe directs the NCBTMB Clinical Rehabilitative Massage Specialty Certificate, which prepares professionals with essential clinical skills and advanced knowledge for musculoskeletal pain/ injury treatment. This innovative program integrates clinical science with hands-on protocols. Grow today! www.academyofclinicalmassage.com.