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.
Often what we massage therapists will do to sore muscles is to apply pressure to them. It might be a lot of pressure or it might be more moderate, but generally the approach is to push directly into the area of perceived muscle soreness. So, what do we do when presented with a client who may not be able to tolerate having our thumbs pressed into their body? Does this mean we have to turn them away and leave them in pain?
If we don’t press directly into an area of tenderness, what tools do we have to alleviate muscle pain? Can we turn off pain without pressing into irritated tissue?
Pain is not “felt” by muscle fibers, pain is “felt” by the nervous system. It is the nervous system that makes muscle fibers contract; it is the brain that controls our experience of pain. Knowing this, I took my client’s head and neck into my hands and began with some very, very gentle contact. I knew that pushing into her neck was not an option and that the only way to alleviate her pain with manual therapy would be to convince her brain that it could relax the muscles and turn down the volume on the sensation of pain. So, that’s what I set out to do.
It’s hard to describe exactly what I did with my hands. The best I can say is that I engaged in gentle handling of her head, neck, and upper shoulders. She found it pleasant and became quiet and visibly relaxed.
Eventually, when it seemed like that part of her body had had enough attention, I moved on and gave very gentle massage to the rest of her body. I didn’t worry that the light contact to her skin was too “superficial” to have any effect. The client said that it felt very, very good and it was easy to see that her body looked relaxed. Her nervous system obviously liked the input it was receiving.
When the client got up, she had no pain in her neck and said she felt an ease of movement that she’d not experienced in some time. Her entire body was relaxed and she was smiling.
No poking, no prodding, no pressure, no manipulation of joints, just gentle input into her nervous system via the skin was enough to bring about an interruption to her pain.
Perhaps we do not have to push hard into sore muscles to alleviate pain. Perhaps, through gentle touch, we can soothe the nervous system into turning off the pain experience. What do you think?
thank you i agree 1000%
thank you i agree 1000%
A gentle approach to alleviating neck pain...
I sure hope so! Sounds like what I may need. I used to get regular massages, but over the years, the percentage of time that I felt *worse* after continued to grow. When it reached 50%, I stopped getting them. However, I've found some relief in cranio-sacral therapy. What was described here also might help. Thanks for sharing.
You're welcome, Karen, and
You're welcome, Karen, and thanks for the comment.
Yes, doing something that makes you feel worse doesn't make any sense.
Individuals differ in their response so no single approach works for everyone all the time. A good therapist will pay close attention to the client's response and adjust accordingly, both at the time of treatment and later as they learn how the client responded after the session. It can take a few sessions for a client and therapist to determine what works best but if a treatment is not yielding results or is making a situation worse, it's definitely time to stop and try something different!
Many people find the gentle handling of cranial-sacral therapy to be quite soothing and this gentle input to the brain via the skin has the potential to turn down the volume on the experience of pain. I'm glad you found something that works well for you.
What we hold inside
This is on point to what you spoke of, but in a roundabout way.
When I was a teenager, I remember going to a movie with my first girlfriend. I was so nervous, and anxious. I didn't know if she liked me, or liked the movie, or even wanted to go see a movie. I had no idea what to expect, or what was expected of me, so I was a complete wreck.
I was gripping the armrest, and I'm not sure if she noticed, but in the middle of the movie she put her hand on mine. In that moment, I knew everything was okay. My whole body relaxed, and my mind stopped the whirlwind. I remember specifically how it felt, a warmth that came over me, and I felt like everything would be okay.
Now, I mentioned this would be a bit roundabout. I don't want a client to feel that 'my first girlfriend' feeling, because it has an underlying sexual component that doesn't belong in massage. However, the fact remains that a simple touch can make a world of difference to another person, and sometimes, simple touch makes far more difference than deep work. In the case of the client you mentioned here, I think she may have been holding herself hostage in her own body, afraid of pain. Showing her that she can be touched, without causing pain, probably opened a floodgate of emotion with her, and relieved that ever-present stress that she kept inside.
This was a wonderful article. Thank you.
What a beautiful story and
What a beautiful story and what a great example of the complex mechanisms involved in an experience that was transformed from "painful" to joyous!
You painted a wonderful, excruciating picture of your state at the time: the excitement of being with this girl coupled with the emotional distress of not knowing how she felt and the physical tension it created. And you see clearly the immediate effect it had with one simple gesture: she touched your arm with her hand. At that moment, with that simple contact, there was communication that spoke to many parts of your brain. The thinking part of your brain now knew that she felt positively about being there with you, the emotional part of your brain could stop feeling anxious, relax, and feel happy, and the "critter" part of your brain could reflexively relax the muscles in your arm that were holding on in fear. What a powerful example of how safe, welcome contact can create a positive change.
Ronald Melzack is a Canadian psychologist who has written extensively about pain and developed theories, based on recent discoveries in neuroscience, about how pain works and the role of the brain. There's a nice illustration of his Neuromatrix Theory of Pain where he describes the interactions of the cognitive (thinking), sensory, and emotional elements that influence our experience of pain. Your story gives a nice example of all these components.
When approaching clients with chronic pain, I think that keeping all these factors in mind and working with them gives us the greatest chance of result.
Thank you so much for sharing your story!
Alice, makes so much sense what you are saying. So many people feel unless the massage is really firm then it is not effective. Definitely feel soothing the nervous system is an integral part of treatment. This is such an interesting area to work in, the elderly need touch so much yet it can be extremely uncomfortable for them. Your initial approach to the massage so nurturing. Thank you.
Thanks, Trina. I've
Thanks, Trina. I've encountered some skepticism about the efficacy of this approach and my response is, "Don't take my word for it, try it yourself." I'd like to point out that in this case, I was not just doing general Swedish style massage but, instead, was applying gentle but focused handling to the area of complaint.
If, as some believe, we cannot alleviate pain without pressing hard into tissue, then we are not going to be able to help a signifcant portion of the population: the frail, the elderly, anyone with a condition that would interfere with their tolerance for pressure or discomfort. I don't accept that as a limitation and think that by learning to work gently but effectively with the body, that we open possibilities for all our clients.
Alleviating pain through a more gentle approach.
It's all a bit horses for courses really. I can completely understand where you are coming from. Very hard to explain it as a technique though, encompasses so much more such as, experience, training, intuition and a passion for your work. You made my day when I read your post. It's all about what is required I suppose and that is as much an art in knowing as the massage itself. Good on you Alice thanks so much for sharing.
Pain is in your mind
'the great doctors treat the mind' .
In contrary to this case, some client want feel the pain from the treatment and some even worry if the massage therapist cheating them by lazy work - in that case, select a total safe area and make sensational signal to the 'customer' to show where the money goes;only after the worried mind relaxed that the treatment modalities can be performed.
My most successful cases are not within this group; but improvement can be made with alternative modification.