We love those questions, and we should, since we believe in teaching advanced pain management. However, what does “advanced pain management” really mean?
Honestly, Advanced Pain Management is a bunch of fancy words that describe a thinking process that then turns into massage strokes. In order to help your clients that are in a lot of pain, you must first be selective about what and where you massage on the body.
Inflammation is a Beast
How then are you suppose to try to help a client who is in pain heal without using inflammatory techniques? I know what you are thinking. You use energy work, aromatherapy, heat, ice, Craniosacral therapy -anything that does not change the tissues a great deal that hopefully will create some kind of change. What do you do if it does not create enough change? That is where Pain Patterns and Solutions comes in.
Disappointment and Inflammation go “Hand in Hand”
Inflammation can be a lesson in disappointing treatment for massage therapists, many health care providers, and the client.
What I have learned in the last 20 or so years that I have been doing massage is that Inflammation is NOT something you can change with what you do. Inflammation is a force of nature that changes what you do. You must respect inflammation to work with it and then can you change the outcome of what it does.
Working with Inflammation, Not Against It
What I want you to understand in this post is that inflammation is basically a lesson in math.
The body of the client in inflammation is very much like this math game. For whatever reason their muscular system is contracting out of order.
Muscles contract out of order when the purpose of the muscle goes from functional contraction to resistance contraction.
Functional contraction is when a muscle can use its ability to contract for the job it was meant to do (flexion, extension, abduction, adduction)
Resistance contraction is when a muscle is required to use its ability to contract to support a structure that is not moving correctly (holding something in one place ALL THE TIME)
A great example of this is whiplash. When the muscles of the neck are healthy, then the muscles can contract correctly for flexion, extension, rotation and so on. You already know from anatomy class that muscles work together and off of each other at the same time.
When one muscle contracts shorter there is an automatic reaction in the opposing muscles to lengthen at a controlled rate to help the muscles move in balance and with control. Once the muscle is done contracting, then it moves back to a neutral position and the opposing muscles contract to pick up the slack, keeping the motion equal. It is like a dance of muscles, all smooth and working together.
When there is an injury to the front of the neck from whiplash, then the front of the neck typically locks down into flexion as the new, neutral state of function. What happens then is that the other muscles of extension, rotation, and lateral flexion are all required to lengthen – which is their job in flexion– to allow the motion. But then they are stuck in that state of length, all fighting against that motion to try to keep the neck balanced.
This is where the “contracting out of order” comes into play.
All those fighting muscles experience a DECREASE in functional contraction. This happens because they using their energy to fight, contracting and resisting non-stop, and only have so much ability left to do what they were made from. It is not that they are weakened from the injury. It is that they are forced to be longer all the time and get tired from having to resist without a break.
When this happens, your client will complain of is back of the neck pain, side of the neck pain, loss of motion in turning and so on. They can flex forward because everything is being pulled into that direction due to the injury.
This is when you have to think and decide where to work to create the greatest change – and not follow what your instincts tell you to do.
After reading the example above it is obvious that working the front of the neck to release the injury will automatically create the changes to all the other muscles fighting against it. However, when your client comes in complaining of neck pain in the back and to the sides, our first reaction is to rub the back and sides – not the front. See the difference?
Presto – No More Inflammation!
The final trick is that if you want the inflammation to finish its job and go away, you need to leave the areas of pain alone (for the most part) because they need to heal.
I know what you are thinking: “Wait! Did I read that right? You don’t want me to touch what hurts?” Essentially, yes. You have to touch your clients pain so that they can perceive the change and to be satisfied. In the game of healing, I don’t set the rules – Inflammation does. And the rule is that a fatigued muscles needs to rest.
Hippocrates Understood This
Massage lengthens THAT IS ALL IT DOES. If you lengthen something that was already lengthened, then you don’t create positive change. You create a longer version of what you already had. If the muscle hurt because it was being lengthen and massage lengthens it further what do you think will happen? More pain and inflammation.
For the whiplash example, that equates to deeply rubbing the areas of pain (sides and back of neck)
Some muscles (clients) will heal through repeated inflammation. Some become sicker and weaker. It will depend on the client.
Math and Inflammation
I call this a math game because in PPS, you basically learn how to move around the pieces of contraction, very similar to the math game in the box. The same rules will apply to massaging muscles to create a different order as the math pieces.
Your goal is to create the correct order (of muscle contraction)
You can’t take the pieces out; you have to work within the boundaries given
If you try to move too much in the wrong direction you will undo what you are
You have to really think and pay attention to what you are doing to get things to line up correctly
Many times, what you think would be the answer is actually two or three steps further out than what you thought or expected
It can be mentally tiring. You might have to make some changes and come back to it later (next appointment)
Then there is inflammation to consider. Inflammation requires you to let things heal before completely lining them up. This puzzle may take more than one treatment (let’s be realistic) to solve. The beauty is that you can decrease pain substantially and the client can feel better while they are healing.
Healing Energy and Space
The last thing I want to bring up is that in order to move those numbers around inside that box you have to have an empty space to do it. If there is no space there is no ability for change.
Massage can be the empty space or can help create that space. There are those clients who have so much inflammation that we must, first, help their body create the space for change. This happens when we help the body drop the level of inflammation, and consequently pain, down to something the body can heal with.
With your hands, you have to find all the areas of shortened tissue (like the whiplash) and get them to change. The automatic result is that the muscles that were lengthened and fighting now get to rest and heal.
Repeated often enough, you can help your client create the space to heal themselves with.
What I hope you gained from this post is that you “hold in your hands” the power to really change the body – if you understand what you are massaging and why you are doing it. Applying your work to the area of pain will work for many, but will not work for others. When that happens you have to know where to go to help the muscles regain their correct order of contracting. That is the only way they can:
Get out of inflammation
In the PPS Basics class, we cover 5 of the top pain complaints and how to create the change in each of those areas. Just like the whiplash example, there are areas of shortened tissue you can work that automatically create change in the lengthened tissue, allowing the muscles to begin to contract correctly and heal. We cover Trigger Points and pain for:
Rhomboids (upper back)
Quadratus Lumborum (low back)
Occipital Ridge (upper neck)
Here are some free videos for the Rhomboid and Quadratus Lumborum. Try the techniques and see for yourself how to massage to “re-order” muscle contraction.
See you next week!
This is a sooth your nerves/muscles/bone pain and inflammation blend. That’s why we call it Balance.
Amy started blending this oil 10 years ago based on the what each of these oils primarily treated for the body. Being a massage therapist she was looking for something to work with the actual body structures.
This is also a great blend for autoimmune conditions.
Our findings using this blend in our practices has shown that this oil can help decrease pain about 2 points alone. If added to your massage session, this oil can provide an added “edge” to treatment.