People come to my office for a variety of reasons. Some come to relax and that’s great. I think if we all got a massage about once every three weeks, the world would be a kinder, gentler place. People would probably be nicer to each other, to their spouse and their kids, and maybe be a little more patient to the guy who cut them off on the highway without realizing it because his mind was on something else or he didn't see you in his blind spot. Massage for relaxation, to "downregulate the sympathetic nervous system" (tech talk for chill out,) for the pure enjoyment of it, is a fine reason to get massage.
Others come because they’re athletes or musicians or have other reasons for wanting to keep themselves in top shape. They appreciate having a body that’s well-tuned, not held back by unnecessary tension or bothersome pain.
I see a fair number of pregnant ladies,. It seems a lot of massage therapists don't do prenatal massage. I welcome mothers-to-be. I love nurturing women during this special time of their life and enjoy helping to relieve the temporary discomfort that often accompanies pregnancy.
One of my primary areas of focus, though, has been in learning how to relieve pain, especially chronic pain. This is an area where I’ve devoted a lot of attention over the years. I spend hours every week studying pain science: reading research and scholarly papers, books, articles, discussing them with other professionals, getting mentored by some who know a lot more than I do and giving mentoring to others who are just dicovering pain science and need help understanding it and putting it into practice. This is where my passion lies, in understanding how pain works and how I, as a manual therapist, can help the client in pain.
When a client comes for pain relief, especially chronic pain, I listen. I ask the usual questions: when did it start, how did it start, who have you seen for it, what was the diagnosis, what treatment have you had for it, what has worked, what hasn’t, etc. There’s a lot to be learned from this information but beside these factual details, I’m also listening to the client’s very personal story. How do they feel about their situation? Are they frustrated? Resentful? Hopeless? Do they feel like they are broken and can’t be fixed? Are they optimistic? Are their expectations realistic? What do they think, how do they feel, what do they believe about their situation? What have they been told about their pain? What do they tell themselves?
And then, most of the time, I offer them some information. I often admit that I don’t know exactly why they hurt and I can never guarantee results. What I can offer is some information that may help, some things that I do with my hands that may help, and some suggestions for self-help. If they are willing to experiment, so am I.
We all have stories. One of the many stories we tell ourselves is the story of our pain. Some of our stories are similar but each is unique. I have my own story and often I share it with clients. I share it for several reasons: one is that I want them to know that I lived with serious chronic pain for at least ten years, so I know what it’s like to live with chronic pain. Another reason is to hold out the hope that they may be able to get out of pain. Each of us is unique and what works for one may not work for another, but if they have an example in front of them of someone who was able to get out of pain after living with it for many years, perhaps it will help convince them that they may be able to get out of pain, too.
I also want to share with them is how learning pain science can alter the experience of pain. I don’t want them to think it’s something they need to do that I have not done myself or that it's a nice idea but not very helpful. I want to share with them how that knowledge has shifted my experience of pain. Maybe it will help them believe that they can do that, too. Their own unique way of learning and integrating pain education into their life may differ from mine, but I want them to know it's possible. It takes time and persistence. It's not a magic bullet to make the pain go away right now. But research has confirmed that neurobiolgically based pain education can make a difference, and when you are living with chronic pain, every small contribution to reducing it is helpful.
I can’t split myself into two and compare my old self and my current self. All I can do is report that somewhere along the way, things that used to hurt don’t hurt as often or as much. I’m currently 61 years old and I have less pain in my life than I did five years ago. I haven’t changed what I’ve been doing all that much. In fact, most of those five years were pretty stressful. I would have expected to have had more pain, not less. Yet I do have less. That may change some day, but for now, I consistently have less pain and I'm grateful for that.
Life before pain education
The easiest way I can describe how I’ve put my knowledge of pain science to work in my daily life is to use a long standing knee problem as an example. A number of years ago I was standing at the kitchen counter, chopping onions, when suddenly, without warning or apparent provocation, it felt as if my tibia (the large shin bone in the lower leg) slipped backwards. This was accompanied by sudden, intense, excruciating pain. I limped over to a chair, unable to put even the slightest weight on it. I had no idea what had happened or why it had happened. After a few minutes, I calmed down. Without weight, it was okay. Carefully, I got back on my feet. I could barely walk. I needed to go to work in a bit. I wrapped it with an elastic bandage. That helped. I managed to get to work and get through the day. Over a few hours, I returned mostly to normal but I had to walk carefully and keep my knee wrapped for the next two days.
I had no idea what had happened and was glad when it was over. I forgot about it. About a year later, I was standing in the kitchen in the very same place, chopping an onion, when it happened again. I thought, what the heck? Is there an invisible black hole in the kitchen floor that I stepped into? Same routine as the first time: hobble to the chair, wrap it, walk carefully for the next two days. A few months later, it happened again. And then six weeks later, again. Now I was getting scared. What if I were out walking, alone, and it happened? I’d have to crawl to someone’s door and ask them to call a cab! (This was before I had a cell phone.) What was going on? Was surgery in my future? That was a terrifying thought.
I finally talked to a physical therapist I knew. She had some ideas about what was probably happening, reassured me it could probably be resolved with physical therapy, and referred me to a doctor. He checked me out, agreed with what the PT had suggested, and prescribed physical therapy. I was told that, in fact, the bone was slipping slightly. The PT made an assessment, expalined why she thought that was happening, gave me some exercises to do, which I was very compliant about doing. It quit happening. I was relieved and grateful.
Some time later it occurred again. It was pretty painful and the timing was very inconvenient because it was the first night of a three day dance event. I ended up sitting out most of the weekend. It happened again another time or two but not as bad as those first few times and each time I remembered what the PT told me to do and followed her instructions. I only had to be careful for a day instead of two or three.
How pain education changed the experience
Then I began to study pain science. I began to learn about how pain doesn’t come from the tissues itself, though it seems that way, but is produced by the brain in response to perceived threat. The next time I got a twinge in my knee, something very different happened. My first reaction was, oh, shoot, there it goes again! Will I be disabled for the rest of the evening? Immediately I began to tell myself a different story. It’s okay, I told myself. I remembered to keep my knee in a “safe” position that the PT had told me about in order to protect it. I told myself look, that was just a warning. Maybe the bone began to move just a little in a direction it shouldn’t really go, that it stimulated receptors that warned my brain that it’s going into a "wrong" place, and my brain generated a shot of pain to keep me from going there. But really, I’m okay! No real harm has been done. My knee is held together very well with good, strong ligaments. The movement I just made was not forceful and traumatic, could not possibly have caused any damage. It wasn't that big of a move. That was just a warning signal. Here, I’ll just sit down for a few minutes and give my nervous system a chance to calm down. So I sat down, put my hands on my knee, and applied a gentle, sustained stretch to the skin, because I know that can be very soothing. I continued doing that for a few minutes while I chatted to the girl sitting next to me, asking her what she’d been up to lately. After five minutes or so, another song came on and a guy asked me to dance. I got up and danced carefully for the first few minutes, asked my partner to keep it a little easy because I just tweaked my knee a bit but really, I'm okay, I think some gentle movement is fine. By the end of that dance, I wasn’t thinking about my knee any more and I danced the rest of the night without pain or any repercussions later.
What a contrast to the way it had always progressed before.
Okay, maybe that night was a fluke. Maybe I was lucky. Maybe I didn’t tweak it as much as I had before. But what has happened consistently since then is that now, when I begin to feel that little tweak in my knee when I’m dancing, I react completely differently than the way I reacted before, when I'd panic and think oh, drat, now I've gone and done it again and I'm going to have to sit out the rest of the night and I'll have to wrap my knee and be careful for the next two days. Now, I bring it out of whatever movement initiated those danger signals, return to a "safe" position, and tell myself really, it's okay, I got the message, got the warning. No harm has been done, I'm taking care of you. It's okay. And so far, every time, after sitting for a few minutes, and telling myself I’m okay, and doing some gentle skin stretching over my knee, and distracting myself with some pleasant conversation with whomever may be sitting next to me . . . every time, after a few minutes it has been okay and sometimes I don't even feel a need to sit out at all, I can just keep dancing. It's been pretty amazing.
Pain is part of life
If you have a functioning brain, you're going to have pain. It's our body's warning system, it's way of protecting us from danger. I still experience pain. Sometimes I get that cranky ache by the shoulder blade most of us feel at times, usually when I’ve been sitting slumped for long periods of time and my back is pushed up against the back of the chair. I think more than anything it’s irritation from pressure on it because it clears up when I put a pillow behind and relieve the pressure on it. We can’t be smashing nerves constantly for long periods and expect them not to protest eventually, can we? Sometimes I'm not really sure why something is hurting. Why is my elbow bothering me right now? I'm not sure. But I tell myself, okay, for some reason the brain thinks there's something threatening goind on. Did I do something to strain it and it's making sure I don't do that again? Sometimes I figure it out, sometimes I don't, but I don't panic. I pay attention. We should never ignore painm, but we can put it into context. Is there heat, redness, swelling, bruising, loss of function? No, no, no, no, no. Okay, probably whatever it is is not that big of a deal. I'll pay attention, make sure that I'm not doing anything to make it cranky, and if any red flags come up that suggest that something serious is happening, I'll have it checked out. So far, the amount of pain I've had has been minimal and short-lived, much more so than in the past. I admit I’ve been fortunate. I have not had any trauma or developed any scary conditions. Little pains come up here and there but nothing debilitating, nothing that has taken up permanent residence so far.
I really do think that studying pain science, running my head over it again and again, week after week, has managed to convince my brain that really, I’m okay, there’s no danger, and that it has learned that things it may have perceived as threatening before really aren't dangerous and that it feels less of a need to generate the sensation of pain.
I could be wrong, but there’s evidence to suggest that pain education can help to reduce and even prevent pain. It’s not a magic bullet to make it go away, but when one lives with chronic pain, every piece of the puzzle, every small contribution that helps reduce the pain is welcome.
Not long ago a massage therapist shared a little of his own story in one of our FaceBook forums. He’d had a chronic pain in his shoulder for several years that had resisted efforts to treat it. He began studying pain science about a year and a half ago. He said somewhere along the way, his shoulder began to hurt less until it hardly bothers him at all any more. He can’t say exactly when or how it happened, but it did. He, too, is convinced that studying the pain science made a difference. He also made a very important point: both he and I run our heads over this information every day. We read it and write it and think about it and talk about it every day. Our clients may hear it once from us and that may be it. They may hear what we say, they may or may not understand it, but they probably aren’t thinking of it much, if at all, because that’s not what most of the world is thinking about pain. Most of the world is saying, well, you have arthritis, of course you hurt. You have a herniated disc, of course you hurt. You’re 50 years old, of course you hurt. Mostly we’re told to expect pain. We’re old, or we’re damaged. But what if every day we were being told hey, it’s unpleasant, I know, and that’s a drag, but you’re okay. It doesn’t feel too good right now but really, you’re all right. There’s some things we’re going to do to try to help you feel better. We’ll put our hands on it, help you feel more relaxed in your body, give you some ideas about movement that may help your body feel safe about moving. What if my clients were hearing that every day? Would they get better sooner? I don’t know.
I do know my clients sometimes amaze me. I don’t fix them. I may be a bit of a coach and sometimes a catalyst, but the change quite literally comes from within them. It’s impressive to see how that plays out sometimes.
Repetition helps us learn
I think if I could make only one recommendation to people living with chronic pain (and I’m assuming here that you’ve been checked out and you don’t have cancer or some dreadful thing that seriously needs treatment, which is why your brain is screaming “Take care of this! This is dangerous!") . . . If I could only make one recommendation to the person living with chronic pain, it might be this: expose yourself to some bit of pain science every day. If you are a reader, read the books Explain Pain and Painful Yarns. Read the blog Body In Mind. Read Todd Hargrove’s book Better Movement. Every day, read something that helps you understand how pain works, the role of the brain in the experience of pain, and something that gives you hope, that reinforces that you probably aren’t broken, that your aren’t doomed. That it may be possible to convince your brain that it is not in danger and can turn off the alarm now. And if you like to watch videos, then I’d suggest that every day you watch a few minutes of Lorimer Moseley on YouTube. He’s on there quite a bit. When you get tired of his stories, look for David Butler and listen to him. There’s probably others, too.
I’ll compile a list of recommended reading and put it at the end of this article so that you have a plenty to keep your brain occupied.
Massage can remind you what it is like to feel safe and relaxed
The other thing I’d recommend is massage on a regular basis, at least for awhile. I know, I’m a massage therapist. Of course I think massage helps and it is how I make my living. But really – massage helps you feel relaxed. It can help your brain to calm down and feel safe. It gets you back into your body, reminds you of what it feels like to move with ease, feel calm, and not worry. As one client told her massage therapist: “I came in with a pain in my neck, I left feeling nicer towards my spouse and my kids.”
Anyway, I wanted to share how I’ve put all this pain science to work in my own life. I hope it will inspire you to give it a try, too. You have nothing to lose but your pain and it's fun learning something new. Don't expect instant results. Give yourself time. Remember, your brain has a history of responding in certain ways and it will take time for it to adjust to the idea that things that may seem dangerous are not, really. Be patient with your body and with yourself and be persistent, too. It takes time to make changes at a deep level.
I’ll start compiling a list of articles, books, videos, blogs, and other pieces of information on pain science that you can use to reinforce your pain education. If you want to be notified when I add something new to the list, send me your email and I’ll put you on my email list. I promise you I won’t spam you to death. You’ll get a few emails about when I’m offering classes, or about gift certificates for massage around holidays, but really, I don’t send out a ton of emails.
In response to a request from a reader, I'm going to try to Tweet more regularly, too, so if you'd like to follow me on Twitter, you can find me at massagestl.
Here’s a start. Whether you enjoy reading or prefer watching a video, there's quite a bit of information here. Some is repetitive but repetition is good, it will reinforce the message. I’ll probably move the resources list to a page of its own as the list grows, but I'll keep it here for now. Have fun and let me know how it works out for you. Also, if you let me know which ones you enjoy most, maybe I can "rate" the best ones so others can find them quickly and easily. If you come across something really cool that you think should be on this list, share it in the comments. If you think this might be useful to others, please pass it on.
Resources for pain education:
Getting a Grip on Pain and the Brain by Lorimer Moseley. 40 minutes. Definitely watch the first 15 minutes. Hilarious hitchhiking story plus some really good info on pain
Body In Mind: The role of the brain in chronic pain. Lorimer Moseley, 24 minutes.
Pain: Is it all in your mind? Lorimer Moseley. 48 minutes
WCPT Congress – Focused symposium: Pain management. Butler, Moseley, Thacker, Louw 90 minutes
The Rubber Hand Illusion. 3 minutes. Not pain science, but a fascinating look at how easily the brain can be fooled.
Explain Pain by Butler and Moseley (Pricey. Kindle version available for half the price of the printed book. Ask your library to get it for you on the interlibrary loan system.)
Painful Yarns by Lorimer Moseley
Pain Science Workbook by Greg Lehman
Treatment Manual Workbook by Greg Lehman
This Train is Bound for Wholeville: A Travel Guide for the Perplexed by Quintner and Galbraith
Pain is Weird, Paul Ingraham, PainScience.com
Does Bad Posture Cause Back Pain? Todd Hargrove, Better Movement
Pain. Todd Hargroves’ list of articles on pain and pain science.
A Tour of Ideas From Recent Pain Science, guest post by Todd Hargrove
Painful Quotations. Paul Ingraham, PainScience.com
Reconceptualizing Pain According to Current Pain Science. Lorimer Moseley
From this website:
Herniated discs, MRIs, and low back pain: Part 1 (yes, I'm really going to write Part 2 Real Soon Now. ;-) )