This article intends to dispel the myth that all therapeutic massage is painful. I will start by outlining the differences between light touch pleasure-inducing massage and deep tissue/touch therapeutic or remedial massage.
In the first instance, “feel-good” massage has been often associated with massage parlours and the exploitation of our instinctual attraction to the pleasureful sensation received through ‘touch’. The pleasure centres of the brain are activated when we are touched lightly and repeatedly by stimulating the excretion of neurotransmitters named endorphins. Endorphins are a drug which the body produces and distributes giving one a ‘sense’ of pleasure. One experiences this feeling when running for an extended period of time.
This sense of pleasure produced by the presence of endorphins is mistakenly often correlated with sexual arousal which occurs when the genitals or ‘erogenous’ zones of the body are touched: eg: tongue, ear lobes, navel, inner thighs, etc. These areas of the body are not targeted or treated during a light touch stress-reducing massage which one receives from a certified massage practitioner trained in basic body massage. The incidence of sexual arousal never occurs within this context of touch when the intention is reducing muscle tone and releasing physical and emotional tension. The intent is not sexual arousal.
Should someone desire sexual touching then a massage parlour would be the right choice for that person and not a visit to a certified massage practitioner or therapist.
This brings me to the definitions and differences between a massage practitioner or bodyworker and a massage therapist. The massage practitioner or bodyworker performs stress-reduction massage without ‘therapeutic intent’ other than achieving pain-free relaxation. This type of massage should not hurt. And when done properly shouldn’t be pain-inducing.
A confusion sometimes arises for the client between stress-reduction massage and remedial massage. The first type is meant to be pleasureful and the second not. The remedial massage therapist, on the other hand, has therapeutic intent of targeting painful areas of the body identified through consultation and assessment and then using deep-tissue massage techniques and range of motion stretches to remove the underlying pain-producing causes.
Who comes to the remedial massage therapist for relief?
I personally work in a ‘fitness centre’ setting. Many of my clients are members who present with multiple kinds of pain: shoulder, neck, arm, back, legs etc. and not in any particular order. My job is to find out how they came to have those pain symptoms(weight-training, running), to reduce the tone of tight muscles, to propose stretches which are appropriate to the joint(s) and muscle(s) involved ; and recommend other hot/cold therapies for the home care and possibly strenghtening exercises for any weak muscles.
Repetitive strain injuries represent the bulk or vast majority of my clients. There is often associated inflammation of the tendons (tendonitis) or of the bursas beneath the tendons(bursitis). The way to tell the difference is that the bursitis is detected with passive movement of the joint whereas tendonitis is experienced with active contraction of the muscle.
There are a few clients who come in who don’t want pain and just want stress-reduction massage and then I modify the massage to suit their needs. Sometimes it is a combination of stress-reduction and therapeutic massage which the client wants.
Within the vast panorama of the human body I encounter many anatomical imbalances some of which are birth anomalies or of a genetic origin and which require modification of my massage techniques. Some clients present with weak muscles due to neurological deficits (meaning that the brain is not communicating adequately with the muscles to make them contract or lengthen).Strengthening exercises are not possible for these clients. The emphasis is to maintain maximal range of motion and muscle contraction to maximize mobility and flexibility.
Most clients come to me with varying degrees of acute or chronic pain. Let me tell you about the nature of pain and how it is transmitted to the brain and how it is felt by the body.
There are two types of pain sensors in the body: a)acute pain sensors(nociceptors) which are located in the muscles and below the skin (subcutaneous). These sensors are triggered by injury or wound. Eg: laceration(cut). When a cut is experienced , then the pain is felt locally at the wound site. The pain sensor will continue to flood the brain with transmissions until the body responds to the healing crisis. The body will respond by sending chemicals to the injury site to stop the bleeding, to clot the wound, to flush out unwanted debris and broken cells, and finally to close the wound and protect it from infection. The acute pain is intense and will only diminish when the healing cycle has been achieved or when we take medicine to ease the pain. This is a euphemism for interupting the pain signals to the brain. When we takes acetominophen or ibuprofen or aspirin for pain what we are doing is taking the battery out of our smoke detector. We are stopping the pain from being felt by the brain. Even though the fire is raging the smoke detector is silent!
Chronic pain, on the other hand, is pain which has been there for a long time following an injury or wound and which changed from acute to chronic and never went away. Or maybe the pain went away but because we re-injured ourselves the pain has returned and becomes somewhat acute again. Or it may stay chronic until a visit to the massage therapist uncovers its presence and with the activation of pressure the pain becomes acute. The injury has never completely healed and the client may be in a rebound cycle from chronic to acute, etc.
Chronic pain, unlike acute pain, is more diffuse and dull most of the time but can become acute when a muscle is strained, such as a low back strain or a shoulder strain.
What makes chronic pain feel different than acute pain is which nerve fibers are used to transmit the pain.
Acute pain gets transmitted by the fastest nerve fibers and therefore reach the brain quickly.
Chronic pain, on the other hand, gets transmitted by slower fibres and can be overridden by gentle stimulation of the proprioceptive receptors at the injury site. Let me explain. The proprioceptive receptors are those sensors under the skin which monitor touch, pressure, and temperature. The massage therapist can use massage strokes which flood the brain with proprioceptive signals which override the chronic pain signals thereby blocking the pain signals from reaching the brain thereby reducing the pain felt by the client. Acute pain, however, at an injury site, is aggravated by pressure or touch which makes it more difficult to treat acute pain directly. That is why therapists use a range of indirect techniques to affect change in muscle tissue or joint mobility when the acute pain is too great to treat the area directly with touch or pressure.
By Roger Richard Fontaine, r.m.t.
For massage services phone: 204-799-3663