At some point during the first intake, almost every new client declares that her body is a “complete disaster”, pointing out everything from tight traps to herniated disks to bad knees. While it is important for us to discuss and address any areas of injury, I am always careful to gently steer the narrative away from “I’m a mess.” We are all in desperate need of a reframe in the way we view our bodies, myself included. I genuinely want to listen to everything a client has going on, and I always want my client to know that she is heard. However, I want to make sure we are also reworking the pathology paradigm, together. Bodies deserve more credit, and as scary or counter-intuitive as it may seem at times, we need to have confidence that our bodies “work”. For the most part, bodies are capable of functioning and healing very well, despite the presence of one or more conditions we consider pathologies, and even despite the presence of pain. Part of the tunnel vision in seeing only what’s “wrong” and the ensuing feeling of helplessness is ingrained in our system of allopathic medicine. I have already written a blog post explaining my philosophy around this here. Unpacking the fear of movement associated with pain and injury is another critical piece in healing. Perhaps the most important piece in this shift, however, is to look at how we conceptualize pain and attempt to better understand its mechanisms.
Thinking of our bodies as being “all messed up” breeds fear of movement, which is counterproductive to healing. We need to make some adjustments when dealing with an acute injury, but smart movement is not only possible but necessary. Strengthening the muscles that support an area of injury as well as any weakened muscles that cause compensation in other areas has been shown to improve overall function.
Gentle, fluid movement increases lymphatic flow, helps the muscles rid themselves of cellular waste, improves joint function and generally decreases pain. The more we are afraid to move, the less our bodies will ultimately BE ABLE to move. If instead of thinking of our bodies as “broken”, we think of them as awe-inspiringly capable, with a few caveats, we have a much better paradigm. This doesn’t mean we have to push through acute pain, continuing to run with an injured achilles tendon, for example. That would be detrimental to the body (and stupid – I’ve done it). This means we can’t be afraid of ALL movement, because there is inevitably some beneficial movement that can be done. These days, even Western surgeons have their patients up and moving just hours after surgery!
Of course the other piece to the fear of movement is the avoidance of pain, which is the tricky and complicated part – especially when we get into the realm of prolonged chronic pain. Chronic pain is still not fully understood. However, recent developments in pain science can help us decipher the multiple causes for pain and what it might actually be signaling. Here is a great article by Lorimer Moseley on pain. I will summarize his four key points:
- Pain does not provide a measure of the state of the tissues. In human pain experiments, researchers were able to deliver a non-harmful noxious stimulus to the subjects’ nociceptors (pain receptors) and elicit a pain response, in the absence of actual tissue damage. In this case, the assessment is inaccurate: there is pain without tissue damage. In the reverse, there can be tissue damage without pain. In the now famous MRI study testing the correlation between herniated disks and back pain, asymptomatic herniated disks were found in 52% of the subjects who reported NO back pain. This experiment has been replicated multiple times, leading to the conclusion that a herniated disk does not necessarily cause back pain. Again, the relationship between tissue damage and pain is not always correlative nor causative – it’s not that simple.
- Pain is modulated by many factors from across somatic, psychological and social domains. Pain is governed by the central nervous system and has been shown to be affected by emotional states, anxiety and stress. In my clinical experience, chronic back pain is often affected more by stress and anxiety than it is by anything at the tissue level in the back muscles themselves. Moseley mentions inflammatory mediators, as well, and through understanding the genomics work that my boyfriend does, I have come to see how chronic inflammation in the body can affect the nervous system and amplify pain. Our own attention to and expectation surrounding pain is yet another factor in pain modulation. Anecdotally, we have probably all had the experience of being engaged in a sport or other physical activity, and looking down to find ourselves lightly bleeding from a cut somewhere that we didn’t notice. Once we pay attention to the cut, it starts to hurt. Studies have shown that if we expect something to hurt, we report the pain as being more intense than if we don’t – and it is postulated that this phenomenon is related to anxiety and stress. Perhaps the most interesting related finding of the studies Moseley cited … believing pain to be an accurate indicator of the state of the tissues is associated with higher pain ratings, whereas believing that the nervous system amplifies noxious input in chronic pain states decreases the perception of pain. In other words, fear around the belief that pain means our bodies are damaged increases pain levels. This is not to say the pain is “all in our heads” – the pain is real, and the fear increases the actual pain.
- The relationship between pain and the state of the tissues becomes less predictable as pain persists. As pain becomes chronic, changes occur in the neural pathways and they become sensitized, causing us to experience increased pain even when the painful stimulus no longer exists. Whitney Lowe, one of my favorite massage educators, explains sensitization very eloquently here and here. Essentially, the nervous system can become more sensitive to certain stimuli once exposed to pain over time. This is common in the case of trauma survivors, and once the sensitization exists, even a mild stimulus can elicit an extreme pain response. The two most common clinical manifestations of the changes in the sensitized nervous system are hyperalgesia (formerly painful stimuli become more painful) and allodynia (formerly non-painful stimuli become painful).
- Pain can be conceptualized as a conscious correlate of the implicit perception that tissue is in danger. In other words, when our brains perceive that we are under threat, pain results as one of the outputs of the central nervous system. Pain is real and can feel debilitating. His point is that the pain output occurs as a result of the perception of threat, not because of the state of the actual tissue.
The good news is that our bodies are not all messed up!
Adopting more proactive beliefs about the body’s potential for good health can help us release some of our fears around movement. Understanding the effects of anxiety and trauma may empower us to seek out somatic therapy. Grasping the importance of proper methylation and controlling inflammation may lead us to seek out the guidance of a holistic practitioner. There is still room for massage therapy in this paradigm, too! Massage addresses the nervous system, and regular massages may help to alleviate some of the symptoms of central nervous sensitization. Additionally, massage encourages body awareness, which is key to understanding pain. It has been shown that even reproducing pain or eliciting a new sensation in a non-threatening environment can begin to rewire neural pathways. As massage therapists, we have the capacity to support agency in our clients by interpreting feedback and learning together how their pain works – we become their partners in shedding some light. For those of us on tighter budgets, simply educating ourselves on the role of the nervous system in pain management is incredibly impactful, as is finding a buddy who will support and encourage smart movement.