Issue link: https://www.massageandbodyworkdigital.com/i/1464088
instinct to fight or flee or freeze (and the pain that results) with the embodied reality of safety. The notion of engaging the brain as well as the body can seem daunting at first. But take small steps. You can make an impact in any and all of the ways you engage with a client—emotionally, verbally, and physically. The possibilities are so numerous that you can experiment with making small shifts in all aspects of your practice, from the lights and sounds in your treatment room to the way you ask intake questions to the particular strokes you do and how you do them. Keep on Massaging! Nothing in this article should discourage you. Our massage work is still useful and valid and wonderful! What pain science shows is that what is happening when you do myofascial release, or the reasons why Swedish massage can feel so good, might be different than what we have long assumed. But our hands-on work is still just as important. As Todd Hargrove reminds us, "Understanding the role of the brain does not mean neglecting the role of the body." 15 There is no reason why any of the modalities you currently use are inherently wrong or bad or problematic within this more advanced understanding of pain. There is no need for you to stop what you're currently doing. But chances are you could use those modalities even more effectively by tweaking your approach and your intentions. Here's how I now see my work: I am manipulating the muscles (and skin, and fascia, and tendons, and joints) in order to impact the nervous system. Whether I am offering gentle shoulder mobilization to an elderly client or deep-tissue strokes into the glutes of a dancer, my aim is to have an impact without triggering the warning alarm that is the client's sympathetic nervous system. This approach L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 51 is the foundation of my "pour, don't push" concept, and it underlies all the continuing education classes I teach. The most obvious takeaway from pain science is that there is no benefit, and much drawback, to intentionally causing pain while we work. Our profession valorizes aggressive work; our nervous systems hate it. Your clients will make more progress—and your own body will be happier—if you work with their bodies, rather than against them. I still work very deeply, but intentionally. I aim for a "delicious discomfort" with my clients, not pain. And I ensure the right amount of pressure by maintaining an awareness of their breathing patterns during the session: I want the client to always be able to slowly and easily exhale during a stroke. A short breath or a sudden inhalation are signs I am working too deeply or too quickly, and thus setting off that alarm. Just as important, I lengthen my own exhalation as I work, which stimulates the other half of the ANS—the parasympathetic, or "rest and digest," branch—and which serves as an unspoken encouragement for my client to find their own slow, easy breath. 16 I encourage you to also experiment with two other nervous-system-soothing possibilities: slowing and leaning. First, I create all my strokes by what I call pouring rather than pushing—leaning with my body weight instead of creating each stroke through muscular effort. The result is that I can work as deep as the client needs without hurting my own body, and without triggering the client's safety alarm. The less we push and press and dig, the more we allow the client to feel deep pressure they can open up to, rather than defend against. Second, we often rush through our sessions, determined to get to all the parts of the body before the time is up. But it is far more satisfying and far more nourishing—for us and for the client—to perform fewer strokes more slowly. When you slow your strokes, you are more attentive to the client's needs, and, just as important, the client gains far more sensory feedback, because you are sinking in rather than racing to the next body part. The client in pain needs that nonthreatening sensory input, to relearn that contact and pressure and movement can feel good rather than painful. Acknowledge and Ally By now it should be clear that the work of our heads and hearts is as consequential as the work of our hands. Let's end by exploring how we can talk—and listen— more effectively. I believe the key is to work in collaboration with our clients: We need to acknowledge that they are the expert on their body, and offer whatever tools we have to be their ally in whatever journey they are on. The always incisive Susan Sontag described pain and suffering as an affront to our "modern sensibility," as "something that is a mistake or an accident or a crime. Something to be fixed. Something to be refused. Something that makes one feel powerless." 17 It is this attitude that many of our clients already have. They come to us feeling powerless, looking for answers. We need to be clear that we do not know all the answers, and that they already know at least some of the answers themselves, and that together we can find more. The research shows that talking with clients about this emerging understanding of pain has clear benefits. Balachandran writes, "It has been shown in recent studies that teaching patients about modern pain biology can change beliefs and attitudes about pain and lower the pain sensitivity." 18 We again need to be clear about our scope of practice, and avoid prescribing exercises or the like (which is the domain of physical therapists and medical doctors). But there is ample room for us to share what we know about this ever-shifting landscape. You likely have mere minutes after your client has gotten dressed and before the next client arrives, but just a brief discussion can be the beginning of a deepened understanding. I find an easy way to begin is simply to say that I am trying to move beyond the outdated assumptions of my profession, and incorporate the new model offered by pain