What can Massage really do?
There is a huge shift in thinking about what massage actually does for our bodies. Historically most styles of manual therapy talk about melting knots, draining lymph nodes or effecting some kind of physiological change on the soft tissue structures, Research is increasingly demonstrating that this is not the case. Instead the benefits of massage are always through affecting the nervous system in a positive way that is safe for the client to “let go” of their pain.
WORKING WITH THE NERVOUS SYSTEM
Massage therapy or any kind of touch is actively engaging the nervous system at the level of the skin & fascia which are richly innervated with receptors that respond to mechanical stimulation e.g. pressure, temperature, vibration, skin stretching, Stimulating the slow adapting sensory receptors has the ability to alter the motor output of our brains and therefore our experience of pain. Clinical scientist & physiotherapist Lorimer Moseley explains in his Tedx Talk “Why things hurt” that:
“The brain is constantly evaluating messages it is sent from sensory nerve endings (nociceptors) embedded in the skin and fascia, which are the first to detect any stimuli.”
If the brain concludes that there is real physical danger (drawing on past experiences, visual cues, etc..) it will create a pain sensation. Pain is a protection mechanism created by the brain to stop you from potentially damaging yourself further. What an amazing thing! And in an acute injury situation totally appropriate. The downside is that sometimes the brain gets stuck in this protective state, and these nociceptors become overactive. For chronic pain sufferers Moseley also explains that:
"Pain is 100% real but no longer accurately reflects the state of the body, or tissue damage".
Apart from the ordeal of living with pain, or any level of discomfort throughout our lives, the problem with remaining in this protective state for prolonged periods of time means that other systems of the body are deprived of the energy and nutrients required to function optimally. This can allow other diseases to fester, especially where chronic inflammation is concerned. It also leads to muscular dysfunctions that become more “stuck” over time and become our characteristic holding postures or movement patterns. The first step with chronic pain is to adjust the environment the nerves live in. Give them temperature and pressure change with massage and suddenly the message shifts. The Jing method combines Eastern and Western techniques that are slow and relaxing, yet focused and specific to achieve a clinical outcome for clients. These techniques reinforce the effects of one another by encouraging the nervous system to relax and allow the body’s natural healing process to begin. Read more. Rehabilitation exercises are also necessary to reactivate weak or inhibited muscles in a non threatening environment (you don’t have to do 100 sit ups at the gym to activate your core, yey!) and forms the basis of an integrative approach to reducing pain in the long term. You can’t cause pain to get out of pain. Your “pain-threshold” is irrelevant to achieving a clinical outcome and over-exciting these overactive nociceptors makes no sense. In a previous blog I’ve written in more detail about why a hard & fast style of massage is not effective.
SOCIALLY CONDITIONED SAFE SPACE
Going for a massage is a conscious choice to step out of the rat race for a set period of time to focus on yourself and your body’s needs with one other person (a trained bodyworker hopefully!) who is devoted also to addressing your needs. The massage therapy room is an intimate space and raises certain expectations (especially as you are paying for a service which can be expensive) so it is worth noting then that there are other factors that affect our response to treatment:
Managing realistic expectations and setting achievable goals (Sorry to those hoping for a miracle cure to their pain of more than 10 years in a one-off hour full-body relaxation massage, but it’s just never going to happen!)
Your beliefs about pain and getting better - does chronic pain run in your family? (pst… pain is not inherited, we learn movement patterns from observation & absorb beliefs from those we spend most time with… All the women in your family suffer with migraines? Of course you’re going to experience migraines if you’re a woman and this is drilled in to you by other women in your family)
Your relationship with your massage therapist - do you trust their authority, do you feel safe with them so that when they access your nervous system using manual techniques your brain is willing to alter motor output and consequently your experience of pain?
These combined responses impact on whether you’ll see positive results fast, slow or even at all e.g. improved proprioception, increased range of motion and decreased experience of pain. As Schleip states
"A change in attitude in myofascial practitioners from a mechanical perspective toward an inclusion of the self-regulatory dynamics of the nervous system is suggested".
Massage can help create an environment for the brain to “relearn” that the messages sent from nociceptors do not always mean that the body is in real physical danger and does not, therefore, need to continue to create a pain response. This happens on a physical level via interacting with the nervous system using massage techniques but also on a psycho-socio level by tapping in to your self-awareness and creating confidence with your body to move with ease through the world and be pain free. In this way massage can help you to manage the outside pressures/stresses (work, advertising, technology etc.) that are constantly stimulating your flight/fight response by being part of the solution in choosing to take care of yourself and maintaining long-term well-being.
A. Woolf 2007 “What healthcare services do people with musculoskeletal conditions need? The role of rheumatology” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856021/?log$=activity
Tavel ME. Am J Med. 2014.“The placebo effect: the good, the bad, and the ugly” https://www.ncbi.nlm.nih.gov/m/pubmed/24518105/
R. Lebert 2015 “Blog: Myofascial release and massage therapists” https://themtdc.com/myofasical-release-and-massage-therapists/
“The Workplace Is Killing People and Nobody Cares” https://www.gsb.stanford.edu/insights/workplace-killing-people-nobody-cares 2018
P. Ingraham 2017 “Does Massage Therapy Work?” https://www.painscience.com/articles/does-massage-work.php
T. Covic et al. “A biopsychosocial model of pain and depression in rheumatoid arthritis: a 12-month longitudinal study” https://academic.oup.com/rheumatology/article/42/11/1287/1788382 2003
R. Schleip 2003 Fascial plasticity – a new neurobiological explanation: Part 1 https://www.sciencedirect.com/science/article/pii/S1360859202000670
R. Schleip 2003 Fascial plasticity – a new neurobiological explanation: Part 2
S. Hitzmann "Pain is a construct of the brain" Published 08.03.17 https://www.meltmethod.com/blog/pain-is-a-construct-of-the-brain/ Accessed 01.09.18
D. Clewely "Why People Seek Healthcare" Published 31.08.18 https://bodyinmind.org/why-people-seek-healthcare/ Accessed 31.08.18
L.Moseley “Why Things Hurt” Published 21.11.11 https://www.youtube.com/watch?v=gwd-wLdIHjs&noredirect=1 Accessed 28.08.18