Myers is not being attacked - but his ideas are. This is as it should be. Mr Erickson posted this to YouTube and it was removed. I consider his response to be of sufficient magnitude that I would like it preserved here for future reference. I received specific permission from Jason to publish this here. It is my hope that it will be read and introduce many to real pain science and give a foundation for further learning.
Tom Myers - Why Does Massage Hurt
This video really disappointed me. A while back, I invited
Tom Myers to participate in discussions of pain science with people that have
serious credentials and expertise in pain science. He didn't participate for
long. It now appears that he never did learn anything from the resources made
available to him.
He has a personal definition of pain, and it's not accurate
because there can be pain without "a motor intention to withdraw". The
best current definition of pain used around the world is from the International
Association for the Study of Pain (IASP) taxonomy:
"Pain
An unpleasant sensory and emotional experience associated
with actual or potential tissue damage, or described in terms of such
damage."
http://www.iasp-pain.org/Taxonomy?navItemNumber=576
I am glad that he acknowledges the presence and role of the
free nerve endings in nociception, but he seems to think that nociception and
pain are the same thing, as if they are strictly a biological phenomenon. This
is also not true.
From the IASP taxonomy:
"Nociception*
The neural process of encoding noxious stimuli.
Note: Consequences of encoding may be autonomic (e. g.
elevated blood pressure) or behavioral (motor withdrawal reflex or more complex
nocifensive behavior). Pain sensation is not necessarily implied."
Nociception is unfiltered, raw data. It is not a sensation.
Some reflexive responses can be triggered locally or at the nerve root, but
there is no sensation until the brain interprets the incoming data. Whether or
not nociception is transmitted to the brain is mediated at the spinal cord
level, and the significance of what the brain receives is mediated by many
different parts of the brain associated with memory, cognition, emotions,
learning, sensation, motor control, etcetera. If something else demands higher
brain priority due to psychosocial contexts, the brain may "ignore"
that nociception altogether.
That contextual interpretation of the raw sensory input is a
critical part of whether or not the brain generates the sensation of pain. In
this video, Tom refers to yoga practitioners experiencing strong sensations
that could be uncomfortable/intense but not painful. He also states that those
who are "reaching their physiological limits" may experience pain.
Those new to yoga, who have not yet become comfortable with
the poses and practices, often lack the contextual learning that would
facilitate performing yoga without pain. The practice of yoga (or other
strenuous physical disciplines) trains the nervous system to interpret sensory
data with a greater discrimination between what represents threat and what does
not.
Like Tom, I do not believe in the "No pain, no
gain," approach to bodywork. I'm more of a "No pain, more gain,"
therapist.
I strongly disagree with Tom's unfounded assertion that
there are "three types of pain": "pain coming into the body",
"pain stored in the body", and "pain leaving the body".
He's just stating his personal philosophy and metaphors/analogies/stories...
let's look at each one:
1) "Pain coming into the body": Here, Tom seems to
think that pain is something that is inevitable from the moment our tissues are
affected in some way. No. We have known since the 1960s that pain is not an
input, and that the nervous system modulates whether or not we feel pain, and
to what extent - that is what precipitated the publication of the Gate Control
model of pain. However, even then the authors knew it was flawed and limited,
and did not explain many known pain conditions. It is true that nociception can
be very important in the processes that result in the sensation of pain, and the
term "nociceptive pain" would seem to cover what Tom is talking about
here.
From the IASP taxonomy:
"Nociceptive pain*
Pain that arises from actual or threatened damage to
non-neural tissue and is due to the activation of nociceptors.
Note: This term is designed to contrast with neuropathic
pain. The term is used to describe pain occurring with a normally functioning
somatosensory nervous system to contrast with the abnormal function seen in
neuropathic pain."
Note the mention of neuropathic pain. Nothing is
"entering the body", it's already part of the body. There is much
more to be said about it, but I'll leave it at that.
2) "Pain stored in the body": Tom basically says
this is experienced as fatigue, malaise, and postural changes... but not as
pain. Here he is misinterpreting changes in posture/movement as pain instead of
as non-painful co-occurring symptoms. As an analogy, it makes a crude kind of
sense, but if we're going to think clearly about our terminology and the
underlying processes of pain and altered motor control, then we need to avoid
this sort of thing.
A body under stress with a nervous system that is
constantly/chronically interpreting threat(s) from incoming somatosensory input
will normally make adaptive changes including autonomic physiological responses
(altered, often increased sensitivity to sensory inputs, altered hormone
levels, circulatory changes, breathing habits, etcetera). These have enormous
impacts on how we experience the world. Our postures, habitual movements,
gaiting, balance, coordination, etcetera may be impacted as well.
I do tend to agree with Tom that the body often attempts to
arrange itself so that it feels less threatened. (He says "pain" but
I think I understand what he's trying to say.) These changes in physical
arrangement are not always associated with pain, however, and may not be
subject to a physical "release". There are psychosocial dimensions
that Tom is not addressing here that are at least as important as anything that
can be done manually.
3) "Pain leaving the body": This is the least
clear portion of Tom's talk. My interpretation is that he is primarily
referring to mental/emotional experiences that are uncomfortable, and that he
seems to think it's important for a person to have some sort of
"remembering" of prior trauma (either as physical sensation,
emotions, or whatever) during their treatment(s).
I am very concerned about this part, because he says he
believes that people can't be treated for pain without them having some sort of
intense physical/mental/emotional re-experiencing of the prior trauma. In my
experience, that's patently NOT TRUE, and I would NEVER, EVER plant that idea
in a client's head. Doing so may actually make it more difficult to help them,
and possibly even make their pain worse by creating a false expectation that
might never be fulfilled... and then the client may never recover fully.
Also, massage therapists/bodyworkers should never have the
intention of inducing such a mental/emotional response in a client. In doing
so, we may actually re-traumatize them. That could make their issue(s) much,
much worse. Besides, it is outside of our scope(s) of practice. We are not
mental health professionals, and should never seek to pretend otherwise.
Instead, it would be better to never mention this idea to a
client, and just work with them. If they have such an experience, just be a
caring professional and give them a safe space for it as appropriate. If they
have questions about such things, just let them know it happens now and then.
Sometimes it's minor, but for some people it can be pretty intense. Keep some
tissues handy just in case. Don't make it a big deal. It's their experience, so
let them decide how significant it is in their recovery process.
Tom also seems to think that we are walking around holding
the collective traumas of all of our ancestors as "stored pain"...
but then he veers into historical contexts that are effectively social
contributions to how we think, feel, and move... and ends by saying that he
thinks personal trainers should help "get the pain out" through
exercise. As a personal trainer and corrective exercise specialist who has
helped many training clients get through their rehab process, I agree that
movement and training can be very effective ways of reducing/overcoming pain.
In some ways, parts of Tom's descriptions of his "three
types of pain" correlate with different aspects of the biopsychosocial
notion of pain that is rapidly becoming the dominant model for understanding
how pain works and how to treat those who have pain. The Neuromatrix Model of
Pain, authored by Dr. Ronald Melzack (who also coauthored the Gate Control
Model), lays out a rough blueprint for understanding how biological,
psychological, and social factors all contribute to how/whether we experience
discomfort, and why.
There is a link to a paper "Pain" about pain and
the historical development of pain science (also authored by Ronald Melzack,
with Joel Katz), in the comments pinned to the top of this page (That was in the original FB post - here is that link: Pain Article by Melzack & Katz. It's an
excellent read, and if you've read this long post, you'll be just fine with
that paper.
Though my personal interactions with Tom have been positive,
I think there is more value in studying the actual pain science than there is
in listening to him talk about pain. I like some of the hands-on methods he
teaches, but I think the reasoning demonstrated in this video is severely
flawed by lack of modern medical knowledge about pain, what it is, how it
works, and why.
This is to Jasons Page Jason Erickson
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