Issue link: https://www.massageandbodyworkdigital.com/i/1464088
THE PROBLEM L ife's aches and pains are a primary reason why people get massage. And if we are doing our jobs right, our clients leave our treatment rooms feeling better than when they arrived. But we can, and should, be doing more. I believe our profession is held back by outdated ideas about pain, and too often we are perpetuating in our clients a counterproductive understanding of their own pain and tension. I say all this with no judgment, only love. Like most of our profession's problems—from our exceptional rates of burnout to our tendency to diagnose and otherwise evade our scope-of- practice guidelines—this problem emerges from our good intentions. But that makes it both a more challenging, and more urgent, problem to try to solve. Think about the language we use. We talk with clients about "taking away" their pain. About "getting rid" of their knots. About "extinguishing" their trigger points. The idea is alluring (for us and for our clients): If we just work hard enough, we can banish pain and knots and tension from another person's body. We can cure our clients of all that ails them. And who among us doesn't want to be able to cure another person of all that ails? But that idea is an illusion, and a very problematic one. I want to offer an alternate way, using the recent insights of pain science, for us to think about and work with pain—and an alternate way to talk with our clients about it. First, we must accept that pain is an inevitable— and beneficial—part of being alive. Therefore, getting rid of pain is impossible and unhelpful. Next, instead of perpetuating a faulty and simplistic notion of the body, we need to help our clients embrace all aspects of themselves, including the painful parts, to help them inhabit their bodies more fully. THE REALITY W e are people of the body. We love muscles. We get pretty excited about tendons and ligaments and joints too. But ask a massage therapist what their least favorite class in massage school was, and there's a good chance the response will come without pause: neurology. This is a generalization, of course, but I think it is a revealing one. Our understanding of the body is shaped by what we can palpate with our hands. The other stuff isn't quite as resonant for us. No surprise then, that our understanding of pain follows suit. My guess is that for many of us, our understanding of pain looks something like those diagrams in our Human Anatomy & Physiology textbook from the first semester of massage school. A cartoon drawing of a person alongside a "noxious stimulus" (anything that can damage tissue)— perhaps a hot stove or a punch in the gut or the thin slice of a paper cut; an ascending neuron relays that painful sensation to the brain; the brain registers danger and initiates the appropriate response (jerking the hand away from the stove, etc.) via a descending neuron, thus avoiding further pain and preventing injury. 2 This is what pain scientists refer to as the "bottom up" theory of pain. (And we therapists are not alone: This is how most humans, I'm guessing, still think about pain.) To be clear, this explanation is entirely accurate. But it is also woefully inadequate. With most pain—from that ankle you sprained playing soccer, to that crick in your neck when you sleep in a funny position, to the dull ache in your forearms after a long day on the computer—there is indeed some kind of noxious stimulus, and then your brain decides how to respond. And yet, this is just one small part of what is actually happening when you hit the turf wrong or wake up drooling in a strange position. For the last half-century, the growing field of pain science has been revealing the startling complexity of what pain really is— from Ronald Melzack's field-shaping notion of the Gate Theory of Pain in the 1960s to today's efforts by Lorimer Moseley and a number of others to "explain pain" to an increasingly desperate public. 3 The wonderful science writer Paul Ingraham sums up our predicament nicely: "Injury and pain are not in lockstep with each other. And yet that is exactly what nearly everyone assumed for a long, long time. And many professionals, even though they may 'know' better, often seem to forget how powerfully pain is influenced by perception, context, and meaning." 4 This is where things start to get messy. Pain is a tricky concept because it seems so obvious. Often, we can point to it—my hip hurts right here. Our old explanations have endured for so long because they seem obvious and self-evident. I can point to my pain, so there must be something wrong right here. There must be some kind of damage, right here. But the more we know, the less we realize that is the case. In the last few decades our definitions of what pain really is have evolved and gotten ever more abstract, tentative, and hesitant. Take the current definition of pain from the International Association for the Study of Pain (IASP): "An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage." 5 Confused yet? You are not alone. 46 m a s s a g e & b o d y wo r k m ay/ j u n e 2 0 2 2