Issue link: https://www.massageandbodyworkdigital.com/i/82405
SOMATIC RESEARCH • Flexibility, loss of balance— balance tests, mobility tests, and range of motion. • Inflammation—heat, pain with movement, redness, and swelling. • Adhesions, fibrotic tissue, scar tissue— palpate restrictions, movement tests. RESEARCH-SUPPORTED TREATMENTS FOR CHRONIC PAIN Massage research can provide insight into potential effective treatment strategies when designing massage sessions for patients with chronic pain. Previously, when reporting on the Highlighting Massage Therapy in Complementary and Integrative Medicine Research conference in my September/October 2010 column ("Research Conferences," page 114), I mentioned a study that found both general relaxation massage and specific treatment massage to be effective for chronic back pain. Understanding the mechanisms of chronic pain as discussed previously, we learned that chronic pain is a nervous system disorder more so than a soft-tissue disorder, hence the success of treatments that induce a parasympathetic state. While the specific treatment sessions were intended to address the original trauma, perhaps they were successful in balancing the compensational patterns that developed as a healing strategy, since it is likely that the original trauma has long since healed. The next step in the clinical decision-making process is to identify treatment techniques that ameliorate the symptoms and are consistent with the mechanisms of the conditions identified. The following are guidelines and treatment options to consider: • Pain, sleep—Never add to the patient's pain experience. Use techniques that are soothing to the nervous system and provide relaxation in an attempt Massage therapy is an alternative to pain medication; however, coaching people off their medications is not within our scope of practice. to enhance restorative sleep. When applying techniques such as trigger point therapy, use pressure only to the point of slight discomfort, never pain, and intersperse specific techniques with general soothing strokes. • Mood, immune function—The mechanisms of massage for enhancing mood and improving immune function are not totally understood, nor have specific massage techniques been found more effective than others. General massage has been found to positively influence mood and immune function.17 • Mobility, balance—Pain limits function. Limited function results in decreased flexibility, mobility, and balance. Stretching, strengthening, joint mobilization, and massage have been found to increase function in those with chronic pain.18 • Inflammation—Massage and movement are important components for reducing swelling. Common techniques include lymphatic drainage, joint mobilization, and effleurage. 120 massage & bodywork july/august 2011 Modalities such as ice and topical analgesics are also beneficial.19 • Scars, adhesions—Manual massage, fascia massage, and stretching have been found to reduce scarring with burns, chronic pelvic pain, and fibromyalgia.20 INTEGRATIVE HEALTH- CARE TEAM Massage therapy is an alternative to pain medication; however, coaching people off their medications is not within our scope of practice. People suffering from chronic pain are typically under the care of a physician. Some are patients in sophisticated pain clinics under the supervision of many providers who are accustomed to a conventional hierarchy of communication. While many of these providers may not routinely refer to massage therapists, they are becoming exposed to us through their patients. Enhance your client's health care and promote referring relationships with primary care providers working with chronic pain by communicating your findings. Those who refer to health-care specialists like massage therapists expect the following information to assuage their legal responsibilities (those who refer are legally responsible for the actions of those they refer to): • Monthly reports—initial findings after the first visit and regular progress reports. • Descriptions of our findings— symptoms, palpation, movement, and visual data. • Proof of progress—measurable changes in symptoms and objective findings. • Treatment plans—what we want to accomplish and the treatment techniques that will help us accomplish our goals. • Self-care education—what we teach our clients to do between sessions.