I recently finished treating a 17-year-old gymnast for chronic to acute pain in her mid-back, hips, pelvis, knees, ankles, neck, shoulders and other areas too numerous to mention. To make this simple, she was a wreck of chronic injury and pain.
For this young athlete, it seemed we were constantly battling with a lack of healing in the body. No matter what approach I took, we could not progress in helping her body heal. She decided she was tired of being exhausted and hurting all the time and took a break from her training. We were both surprised when she started hurting more – a lot more.
After sending her to her physician to rule out any other conditions, I finally dawned on me that I should ask about any over-the-counter medications she was taking. She told me that she was taking some form of OTC non-steroidal, anti-inflammatory medication up to 4 times daily and had been since she was about 11. That meant she had been on anti-inflammatories for 6 years. Bingo – the source of non-healing was found.
Our treatments took almost 1 year to go from managing pain to starting the real healing process because of that one factor I wasn’t aware of. Why would this be important to know as a massage therapist?
Because, at the end of the day, massage heals through the inflammatory process
OTC medication can and will stop parts of the inflammatory process from working
In essence, they client continues to hurt and not heal with massage increasing the pain and inflammation.
As a massage therapist, I cannot tell someone what to do when it comes to medication. It is beyond our scope of practice. Because of this, with regard to inflammation, we have a biological and ethical issue occurring with many of our clients. Unfortunately, both can undermine our best efforts to help someone heal.
I believe that knowledge is power and I want to offer you some information that might help both you and your clients understand inflammation better. They can make their own choices for their body with correct information and of course, after talking it over with their doctor.
Inflammation: How Our Body Heals Itself
We hear about inflammation EVERYWHERE. We are informed daily that we are a society of people that have high levels of inflammation – higher than ever in history. Allergies abound, joint degeneration is the norm, and auto-immune diseases are epidemic.
If you have a “pain”, take some Vitamin I (Ibuprofen) and you will feel better and you do! For a while…. Until it starts to show up in other areas of our body from ulcers to increased risk for heart disease, increased injury to tendons and ligaments from normal activity, slower healing time for small injuries, and more chronic pain sufferers.
The inflammatory process is the body’s response to healing for just about anything. This process has certain biological steps it must go through and complete to do its job correctly. When allowed to complete these steps, this process is just short of miraculous. I can equate this process to allowing a car mechanic to fix a motor while its running and driving 80 mph down the freeway. Its impressive what the inflammatory process does for our bodies that we don’t really see happening.
The inflammatory process is run by the immune system. The overall process and raw materials in general come from our immune response and readiness.
Phases of Healing
For injuries, there is a containment and clean up phase, a rebuilding phase (typically Scar Tissue), and a completion phase. In each of those phases, there are chemical and biological processes that must occur in specific orders to be able to have the finished outcome at the end of it all. That outcome is the healing of a tissue or structure that can continue to work with the body as a whole unit.
Swelling is a normal process of inflammation in the containment phase. Too much swelling can cause tissue damage that the body will have to clean up and repair. A certain amount of swelling is required but after that it is damage control. Anti-inflammatories can actually help the body in the containment, clean-up, and rebuilding phase because it eliminates un-needed damage caused from OVER swelling. This is a great factor in surgical procedures and injuries for recovery and healing.
After that, rebuilding MUST occur to create a strong build of rehabilitated tissue. Unfortunately, anti-inflammatories used long term in this phase don’t allow the tissue to complete their building phase. The anti-inflammatories stop the production of certain materials needed to heal and the repair area becomes weakened.
It is like building a sky scraper without the correct supports at the base level. At some point in the construction, with some of the pieces missing, the structure fails and topples over. For the body, what that means is that swelling and clean up starts again and construction starts over.
This process will repeat long term, creating a weakness to the tissue and a depletion of the inflammatory system as well as the immune system. The immune system then starts into depletion along with exhaustion. In this phase, you can sometimes see immune related or sometimes auto-immune issues start to surface.
Pain and Inflammation
There is pain associated with the inflammatory process. It is actually one of the requirement to “turn-on” the system. There is a direct correlation with the amount of pain you experience and the amount of inflammation you have. The more pain – the more inflammation. This is not a bad thing (although it feels bad). Typically, more pain means there is a bigger problem and there needs to be much dedication of the inflammatory process to that area(s). Reinforcements flood the area and get busy!
Pain also makes us quit moving. This does a couple things for the body. It helps isolate an injured area further and re-directs energy from normal activity to helping the inflammatory process.
When you take anti-inflammatories for chronic pain, the problem is 2-fold.
The body doesn’t sense as much pain and therefore dials down the inflammatory process, not completing its job because it can’t sense what is going on or it doesn’t have the needed materials for repair.
You move more because you no longer feel as much pain. This allows partially healed or damaged tissue to move, creating more damage. Cycle repeats.
When Should You Take OTC Anti-inflammatories?
I don’t have all the answers here. I just understand some chemistry and the outcome “feeling” of what a body does or doesn’t do in the healing process as my client. In these situations, the question I am always asking myself is why is a client not progressing towards healing? If what I am applying should work for most people and is not for a few clients, I want to understand all that I can to help that person heal.
Anti-inflammatories work best with the following guidelines. Take them:
Under the supervision of a doctor
For the short term
In Acute Phase (think PMS or the first few days after an injury) not Chronic.
Long term use of OTC anti-inflammatories can have some not very good side effects. Here is a great article with several scientific sources about long term use of OTC anti-inflammatories.
Non OTC Anti-Inflammatory Treatments -What Do You Do for Chronic Pain?
IF you have been taking anti-inflammatories on a regular basis and you decide not to take an OTC medication, you need to have a plan. When you allow your natural inflammatory process to go full steam ahead, there will be some aggressive healing occurring and that means pain is involved. This is good! It is part of the healing process. But that doesn’t mean you can’t use other things to help make the healing transition more comfortable.
Talk to your doctor, listen to your body, and find a natural alternative if possible.
Massage therapy, Chiropractic, Acupuncture, aromatherapy, regular exercise (you might be surprised), or SLEEP are some of your options. Many times we are just plain tired and need rest – that can be what pain is telling us. No matter what your choice it, you must honor your body and help it heal itself, not stop it from healing itself.
In the long run you are healing your body to a much better level.
By allowing the inflammatory process to finish its job, you are actually healing and most likely preventing more injury.
My little gymnast client, I am happy to say, feels like she is 10 years younger. She also has much better physical and pain boundaries and is able to perform better than ever before – without injury.
It Is All About Balance
This is a great time to bring out that as a massage therapist you can offer your clients an alternative (technique or product) that they can purchase from you to help them as they heal.
For a technique, having a hands-on tool in your tool bag that doesn’t create inflammation but can fight pain is a must.
For a product to sell, it doesn’t have to be an expensive product – just something that you know that can help your client manage their body in this transition time or anytime they need it. There are many options out there that work and you should spend time researching if you want to offer an alternative.
For myself, there are 2 things I use for pain management sans anti-inflammatories.
I actually call myself an advanced pain management body worker because that is all I try to do. Eliminate pain so that the body has more energy to heal and finish the inflammatory processes. But there is a twist to what I do:
I use PPS bodywork for pain clients. This bodywork is all about helping the body find balance and relief from pain while at the same time NOT creating more inflammation. My goal is to help the body heal itself.
Check out the free videos for pain relief of Triggerpoints in the Rhomboids without Triggerpointing.
There is an essential oil I blend I use on myself and on my clients for inflammation and auto-immune (as I found out later through those using it). It is a blend of oils I have used for years and finally, after being bombarded with requests, put it together for people to buy at amybradleyradford.com
It is inexpensive and can help decrease pain about 2-3 points (on a 10-point pain scale). Combined with PPS techniques, a hot bath for “tired pain”, an ice pack for “over-use pain”, and REST, you will be surprised at how effective it can be.
Using an alternative for pain management allows you to see, and feel, how efficient your inflammatory system can work for you and how short lived pain can be.
I hope that you have gained some new tools about how inflammation and anti-inflammatories work. Happy healing!!