No Pain No Gain?

A very frequent thing that I hear as a massage therapist is that people really believe that unless it hurts – massage is not going to help.  The message is delivered to me in many ways.  Some people come in and ask for “deep tissue massage.” Others tell me to press as hard as I can – they can handle it.  Many relate positive results of previous treatments with other therapists.

There are many reasons for these requests.  Many believe that their posture needs to be improved and that the only way to do this is to have someone use a good deal of pressure to put things “back in place.” Others believe that their muscles are so tight that only tenderizing them like a piece of meat will work.

My preference in these situations is to ask why they are coming to me in the first place.  They usually mention some type of pain that they want to go away.  They have been to many other practitioners and now they are in my treatment room.  They often give me an overview of their life and health history.  This is where I get some of my best indicators of what needs to be done.

Almost without exception I learn of multiple stresses in their life.  We all know and have lived the litany of problems at home and work, health issues, and whatever maelstrom they happen to inhabit.  Now they are with me. 

At this point I like to point out that I don’t fix people.  Surgeons do that.  I explain that the skin contains nerves fibers that report to the brain.  There are danger receptors (nociceptors) and receptors that tell the brain where they are in space and what is happening to their skin (mechanoreceptors).  My work currently focuses on activating the second group instead of the first.

Some therapists and those who like to see them prefer techniques that activate the danger receptors.  It feels good and both the therapist and the client can testify to the good results.  It’s hard to argue with results.

So why are painful treatments giving the good results?  Why on earth would anyone argue with such a thing as a good outcome?  If everyone involved is happy – why don’t I do the same thing?

I did do the same thing.  I did it for many years.  I treated a huge number of people.  I believe that I do a much better job now.  To understand what I was doing, let’s take a look at how the nerves in the skin send their information.

The type of pressure that activates the danger receptors is usually perceived as somewhat painful.  This is because it creates a little inflammation.  This is one of the ways to activate the danger receptors.  The brain uses this opportunity to release chemicals (endorphins) to decrease the sensitivity of the spine to input from the danger receptors.  This is sometimes called descending noxious inhibitory control.  Endorphins also affect the brain in a number of ways. 

One of these ways is to create dependence on themselves.  People need more and more of a release from this chemical soup to get the same effect.  The effect is very similar to drug addiction.  This is a way in which deep painful massage can feel good but lead to problems over time.  It is why I do not like to give painful treatment.  This link discusses the brain controlling pain: The Drug Cabinet in the Brain

The other receptors respond to pressure and stretch in a good way.  The brain receives information about where the body is in space and of pleasant pressure.  It then takes that information and along with a good deal of interpretation by various parts of the brain that have to do with it’s history and deeply held beliefs and affections – gets to output relief.  This is the effect of activating our parasympathetic nervous system.  This is what massage is justifiably famous for.  This link will discuss how what we believe affects how our brain interprets information:  Why things hurt - the Brain

This is why my treatment tends to entail more gentle pressure and stretching of the skin.  The light pressure approach can be seen to be effective by the flexibility that usually returns to the muscles and the changes in posture that happen at the end of the treatment.  It is not my goal to change posture or increase flexibility.  It is often how your body chooses to respond in response to gentle non-threatening treatment.  It is the result of “First – do no harm.”