A couple of years ago, one of my Pain Patterns & Solutions Bodyworkers asked me to write a post about PPS bodywork as a resource for clients so that they could understand how PPS works. I have started this post several times but honestly it has taken me a couple of years to really bring all those thoughts together in a way that made it simple to explain.
I don’t think she knew at the time how much her request has inspired me. Ever since she asked me to write this, I have been trying to find a way to simplify what PPS is. It was hard to pull all the pieces of 30 years of study together in a way that I could just sum it up. However, in doing so, I have come to understand what PPS is so much more. (Thank you, Danielle).
This post is written to speak to the massage therapist with some guideposts for the client.
Pain Management Massage Therapy
The PPS Advanced Pain Management Technique teaches the therapist how to work more effectively with inflammation as a malfunctioning system. By correcting inflammation as pieces of a system, and not just a location, it creates an opportunity for muscular correction and positive pain management.
When it comes to pain management massage therapy, there are typically 2 types of clients that come to you for treatment. I call these individuals Client A and Client B.
Client A responds well to most treatments that create therapeutic inflammation such as deep tissue, sports massage, trigger point therapy, etc. You can skillfully manipulate (massage) muscles which can reduce pain and increase function at the same time.
Client B does not respond well and typically gets worse or inflames more, even with basic massage or therapeutic inflammatory treatments. If you think about your current clientele, you can start sorting them into these 2 categories. These are the clients that don’t seem to get better or can’t progress past a certain point of pain management no matter what you do. These are your B clients and they will fit into the PPS treatment model requiring inflammation to stop, and that system to recover, before you can change muscles and pain.
Client A has issues comprised of muscular contraction simply being “out of order”. Positive change occurs by relaxing areas of tension or restriction which re-establishes kinetic or functional relationships between muscles.
As a basic model, think about the contraction relationship between the biceps and triceps. If the biceps for some reason is over-contracting, then the triceps is forced to over-lengthen (functional relationships). The chronically lengthened muscles become exhausted and experience micro tearing and inflammation. Pain is then felt in the triceps and/or along with any of the muscles supporting the triceps such as the infraspinatus, teres group, subscapularis, etc.
Massaging the biceps and getting it to lengthen automatically restores “balance” to the triceps and all those muscles because they can return to a more correct length experiencing better function.
Client B has an “out of order” inflammatory system causing the muscular system to respond as one whole unit. All kinds of contraction relationships are not working all at the same time. When you can see this larger concept, then you begin to understand why it does not work to locally treat muscles to change inflammation. You must apply massage in a way that stops inflammation (not creates it) to have the opportunity to change the muscular system and ultimately offer effective pain management.
The confusion for massage therapists are that both types of clients complain of “pain” and sometimes it is the exact same pain. The only clue you get as to whether its a muscular issue or inflammatory issue is how the client responds. If they don’t respond well or inflame further with your work, then they need correction applied to the inflammatory system first. That means you have to treat the body as a whole in a specific way to change all areas of pain. This is what PPS does.
Inflammation Has a Tissue it Creates: Scar Tissue
The biggest difference between other types of bodywork and PPS Bodywork is that PPS trains therapists to work with the only tissue produced by the inflammatory system – scar tissue. This tissue obviously forms in areas of injury to heal but it also has significant secondary reasons that it forms.
Secondary scar tissue can be formed heavily to maintain balance of and for the whole body. There is a specific reason why it does this (below). This scar tissue likes to form on top of bones, heavy areas of fascia, tendons, and ligaments. It forms in these locations because unlike muscles, these areas do not move providing a solid surface in order to restrict motion. Its whole purpose in restricting movement is to hold the body in such a way that it can create equilibrium and balance for the brain.
These heavy areas of restriction can cause muscle tissue to over-lengthen to compensate in a similar manner as the biceps/triceps analogy. However in this instance, scar tissue represents the biceps and all other muscles represent the triceps, creating a body-wide change with multiple areas of activated pain occurring at the same time.
Scar tissue and its role with equilibrium and balance is a very large concept in PPS, but for simplicity of this post I will sum up secondary scar tissue and its role in that balance.
Any equilibrium imbalance of the body is perceived by the eyes through the vestibular ocular reflex. This reflex keeps your head level for optimal brain function and proprioception. ALL muscles will automatically respond to this reflex to keep the head level by changing lengths (shorter or longer, whichever is required), however the spinal column muscles are specifically involved. The contraction ability of the erector spinae group is hardwired into this reflex. This group of muscles will micro-adapt muscular positions in your entire spine to place the eyes, and therefore the head, in a level position when opposing gravity. These micro-changes can create a domino effect that trickles out into all the muscles of the body, changing the length and function of many of the main muscle groups. These muscles end up swapping out the freedom of contraction and movement for “holding” with static contraction.
These “holding” changes show up as fatigue, pain, loss of function, muscular tearing, roaming pain, and ongoing inflammation, typically in many places at the same time. It all depends on how much adaptation the body has to go through to maintain that leveling of the eyes. However, the muscles have no choice. This is all part of a protective reflex for the brain and what the brain requires will be carried out.
I have often said that the body will sacrifice its muscles for the brain. This is what you observe in the Client B body. Muscles are dysfunction everywhere regardless of the pain felt or the wearing of joints. All of this occurs and is ongoing to support the brain leveling reflex and to have optimal functioning for the brain.
What Pain is Telling You
Welcome to the real issue behind Client B and the inflammation their body is experiencing.
Perhaps, now you can see why their pain is different. It isn’t in just one muscle or group of muscles. It’s a systemic problem involving the entire muscular system. It will manifest as pain in any weaker area first. Those areas of pain are simply telling you a story about an active reflex in the brain.
In the PPS program, Trigger Points and pain patterns are taught like a matching game. The location where pain shows up is basically a guide, instructing you on how to trace back through the domino effect that occurred from imbalance of the eyes. When you have the tools to observe the body differently, pain has the profound ability to show you where scar tissue has formed that is creating the dynamic muscular shifting.
Sometimes the pain can be close to the area of scar tissue that is holding the pattern. Sometimes a holding area is so distant from the pain that it can be hard to identify. Sometimes the scar tissue is an injury and that scar tissue that formed to heal that injury is what threw off the reflex of the eyes. Sometimes the pain can be from the scar tissue that formed to create balance for the eyes from that injury. It is such an amazing system that is brilliantly complicated and beautifully simplistic all at the same time.
However, like I tell all my students, the body is mathematical. There are only so many possibilities that can manifest and the answer is always there, and there is always an answer. My career has been spent sorting out each piece and every pain pattern to have a system for success. And I am still learning.
Scar Tissue is a System that Can Hinder or Heal
Have you ever felt like no matter what you do or the type of massage technique you apply, muscles just return to a painful state session after session? Like there was some invisible forcing muscles to fail?
Those invisible forces are the mechanisms and reflexes required for the brain to be level. The muscles will always answer the call for balance even if they must sacrifice themselves to do it.
The PPS theoretical approach is simple. Once the eyes stop fighting for balance, inflammation calms because scar tissue stops being formed for the secondary reasons. When the eyes can return to “neutral” then all muscles can returning to their optimal “resting” states.
“PPS uses massage in specific approaches to reestablish correct balance for the brain which then automatically changes muscles (sometimes without ever touching them) so that they can heal”. That’s the definition of PPS but it doesn’t make sense without this explanation.
At some point, balance is reestablished, the reflex stops responding, and you can stop working scar tissue and begin working muscles as a rehabilitative type of approach. Client B will shift into Client A – for the most part. As a side note, you should not use PPS work on Client A. It will put them into inflammation (and that is interesting concept by itself). Another one of my favorite sayings is “if the toaster isn’t broken don’t try to fix it” meaning there is no reason to apply inflammation changing techniques to non-inflammatory issues. It will “over-correct” causing the body to become unbalanced and force inflammation to respond to rebalance.
PPS is simply a tool for your hands and practice. You use this tool when the job at hand requires it.
Rehabilitating Balance and Muscles
To create this body wide change, therapists shift their focus of massage to areas of scar tissue found in surgical scars and injuries along with working on top of bones, ligaments, tendons and large areas of fascia. Most therapists are trained to avoid bones and therefore its a new and sometimes “taboo” area to perform massage. That’s why you haven’t found these areas before. You will find that massage performed on top of the scapula, clavicles, sacrum, ligaments of the sacrum, heels, head, tendons of the hands and feet and many other solid surfaces creates positive change almost immediately.
These areas of scar tissue always form in pairs. PPS bodywork teaches pairs, locations, combinations, and basically how to read pain to know where to work for corrections.
Muscle work is minimized until the body starts shifting out of inflammation and then the muscles can tolerate the push towards healing. It is still very important to touch someone’s pain so long as you don’t apply pressure in such a way that an over-lengthened muscle has to lengthen more, creating localized inflammation. This is why treatment has backfired in the past for Client B.
Overall, PPS helps the body balance and pain decreases in muscles much more quickly then before because these muscles no longer have so much force placed on them to “hold”. Its hard for a muscle to try to function and contract when so much of its capacity has been redirected for “holding” to balance the brain.
True healing begins because the muscles can rest and recover instead of constantly contract to hold a position. Muscles will fatigue and fail in this capacity. That’s why pain and inflammation never stop in this cycle.
As a therapist, you need be willing to match what the body needs, walk the journey of healing with them, and allow them to heal. All without increasing inflammation through the massage techniques you choose to use.
A New Path of Learning
I call PPS “manual medicine”. It is not just massage and sometimes it doesn’t even fit into that realm. You are literally changing the brain, nervous system, immune system, inflammatory reactions, muscular contractions, and more all at the same time all through one tissue – scar tissue.
It is interesting to know that in Chinese medicine scar tissue is both Yin and Yang. It depends on what it is being used for. Scar Tissue can be used to heal trauma and repair towards healing or it can form in an attempt to try to stop the body from going further out of balance, creating immobility, pain and more inflammation. Scar tissue is the universal tissue that the body uses and depending on the use it can be used to heal or it can cause more pain and inflammation, ultimately perpetuating itself.
There is a lifetime of study that can occur with just this tissue, how it responds in the body, and also to principles of physics. We have all learned that for every action there is an equal and opposite reaction. But believe me, you have no idea how much scar tissue will follow this principle deeply until you start working with it and the system it creates.
PPS is a minimum 2-year study of theory and hands on techniques PPS Online Certificate Program. It is not easy, however you will find answers that you have been looking for. It is more about how you think than how you apply massage. It is beyond rewarding. You will never look at pain the same way again.
And believe me when I say that true pain relief is a commodity as real as money.
I have spent my life trying to grasp these concepts because I am a Client B. This all started with me trying to heal my own body from a car accident at 20 and then using what I learned on myself and others. And here we are, so many years later, with a new understanding of pain through the brain and scar tissue.
Someday, I know this work will change how we all understand pain and inflammation. Until then, I just keep trying to give people a glimpse of something different without overwhelming them. Because it is so complex and different, people struggle with it. I cant always find the data to validate these theories through anatomical or scientific research. But I can tell you that when someone finally has relief from pain, they don’t care what the validity is. They ask that you keep doing that PPS stuff so that they can keep having true pain relief. And that is what matters most to me.
This following resource is intended for massage or hands on professionals (with licenses).