Massage Therapy and Persistent Pain

There’s not many of us who don’t appreciate a good massage. Rubbing and kneading our muscles is our “go-to” when we’re experiencing pain. It feels good, if for only a small amount of time. It can decrease our pain and give our brains something else to focus on when we hurt. In this blog post, I will try to answer two questions:

1.      What can massage therapy do for those living with persistent pain?

2.     Is there anything else patients can do to achieve lasting results?

The answer to the first question is simple: massage can help make pain more manageable. This is possible because of the remarkable capacity of our nervous-system to turn-down the intensity of pain we experience. Something profound happens when we are touched. There are many complex effects in both brain and body that contribute to that magical feeling of relaxation and rejuvenation that occur after you have had a massage. These effects are beyond the scope of this blog to describe. Let’s just say, that by adding sensory input to our nervous-system, it has a chance to change its output or, in other words, decrease pain intensity. A perfect example of this is when you bump your shin and it hurts like heck until you reflexively start rubbing it. This is kind of like the brain receiving competing messages simultaneously but can only hear the loudest one. Of course, receiving a massage is a lot more complex than that. For one thing, no one receives a massage devoid of context. A warm room, peaceful music, and comfortable bed, coupled with an attentive and caring therapist will help turn down the nervous-system’s fight-or-flight response. This, in turn, can help decrease pain. This is called hypoalgesia, a fancy word for "less pain". And this is what most people are hoping for when they seek massage.

 

We know massage can decrease pain, but what else can it do? Something less obvious, is the effect of massage on how we move. It makes sense that when our pain becomes more manageable, our movement becomes easier, leading to increased confidence and resilience. This means getting back to the activities we love to do, making us happy and decreasing stress. And less stress will have a positive effect on almost everything in our lives. So, we could say the benefits of massage have a cascading effect reaching many facets of our lives.

Something I often hear from patients is that they feel great after the massage, but within the next day or two, their pain returns. Why is this? Well, for starters, there are 168 hours in a week, and probably only one of those is spent having a massage. The other 167 hours are spent doing all the things that got us seeking massage in the first place. Our beliefs and established neurological patterns probably play quite a large role in the persistent pain experience. We all have habitual ways of moving, sitting and standing that may not always be optimal for us. These things do not change overnight. For someone who has been experiencing pain for a short while, one hour of massage may be enough for their nervous-system to make a change in how they feel. Kind of like a car veering off the road needing just a little nudge to get back to centre. But for those with persistent pain, their nervous-systems has established a baseline that includes pain, and it may take more than just an hour of massage to make any lasting change. This scenario is more like a car that has veered off into a ditch and will need more than just a nudge to get back up on the road.

But for those with persistent pain, their nervous-systems has established a baseline that includes pain, and it may take more than just an hour of massage to make any lasting change.

So, what can we do to extend these short-lived benefits? Well, we can start with education. Knowing a little more about what is really happening when we are in pain has been shown to have benefits (ref). A common belief is that when we’re in pain, there must be something damaged inside our body. Or worse, the pain is an indicator of some seriously ominous disease. So, it’s not surprising that, for most people, pain of an unknown origin can lead to fear and stress; fear of living in pain the rest of their lives, unable to do the things they love, unable to live life to the fullest. Research suggests that these feelings can actually make pain worse (ref). However, it is possible to decrease the fear surrounding the experience by learning the basics of pain science.

The key point here is we don’t need physical harm to experience pain. Just like your car doesn’t need to have its window broken to have the alarm go off.

This starts by acknowledging that pain is a survival mechanism and exists to protect us. Without it, we wouldn’t live very long. It is a response by our nervous system to any threat, real or perceived, and doesn’t necessarily mean we are damaged. The key point here is we don’t need physical harm to experience pain. Just like your car doesn’t need to have its window broken to have the alarm go off. If we can just wrap our head around this concept, it can shift the way we view pain and, subsequently, decrease threat. This is not always easy and requires diligence on the part of both therapist and patient.

The concept of pain education has inspired a slight modification of the very popular saying: “no pain, no gain”. This has never been one of my favorite maxims. However, if we just add a couple of letters, it looks like this: “know pain, know gain”. I like this one much better, it’s more truthful, and less painful. Unfortunately, pain education is by no means a magic bullet. But, by adding it to massage and good movement, we can increase the chances of a positive outcome.

But knowing is not enough, we have to put what we learn into practice. You can spend hours learning exactly how to shoot a jump-shot, but without putting time in at the gym, shooting ball after ball, proficiency will be elusive. It’s the same for those with persistent pain. Learning how to move with confidence takes time and practice. It’s one thing to know that nudging our movement towards ever more challenging feats will build confidence and resilience, but to actually keep with it through all the ups and downs requires dedication and maybe some active cheerleading from family, friends, and your therapist.

Here’s a quick summary:

  •  Massage feels good and can help make pain more manageable.
  • Our nervous-system has a remarkable capacity to lessen the intensity of pain we experience.
  • Less pain means easier movement.
  • Good movement takes practice, and nothing changes overnight.
  • Pain doesn’t mean we are damaged and learning this can help decrease the fear surrounding the experience.
  • Know pain, know gain.

Thanks for reading.