http-equiv='refresh'/> Global Therapies: Pain

Wednesday, 18 May 2011


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We all experience pain, be it emotional or physical, at some point in our lives. Some people are lucky and only experience pain when they are injured, like when they twist an ankle running in the fells or cut themselves accidentally while chopping vegetables. Other people seem blighted with pain, going from illness to illness, often (and frustratingly) without a specific cause. But pain is pain, whatever the cause or reason for it. And the level of pain we feel is on a continuum, and it is difficult to be precise about this as ones own pain tolerance is unique. What is clear is that massage can be highly effective at reducing or eliminating pain, we'll see how below.

The degree to which you react to pain comes from many sources: biological, psychological, cultural - essentially pain is subjective because of who we are and what we have experienced and been influenced by in the past.

On a physiological level, the perception of pain is caused by the stimulation of nociceptors (sensory receptors) - either chemically, mechanically or thermally. The point at which a stimuli is perceived as pain is known as the pain threshold, and interestingly, this threshold is pretty similar for every person. It is how we react to the perception of pain which can be dramatically different. Some people are able to inhibit pain sensations, whereas others magnify them - for the reasons mentioned above. It is behavioural and emotional responses which either inhibit or magnify the perception of pain. So whether we are anxious about being hurt or withdraw from situations which may cause us pain, or whether we choose to accept that there is some risk of injury, is what makes us and our reactions to pain unique.

The nociceptors which detect pain send a signal to the brain via the spinal cord. That signal can be reduced by endorphins or increased by substance P (a neurotransmitter released from sensory nerves). Massage can influence these signals (for the better, i.e. reducing or removing pain sensations) and chemical responses, although the mechanisms of this are not clear.

What is interesting is that if somewhere in your body is painful (whatever degree or level that is perceived) then the muscles in that area can exhibit sustained contractions, which in turn restricts the blood flow through capillaries to the constricted area. The restriction of blood flow means that less oxygen is being delivered to the area and ischemia develops. Even a short exposure to such conditions (from a direct trauma or injury) can produce ischemic pain.  If local metabolism is increased like when a strong contraction occurs, then oxygen is burned quicker and the sensation of pain is not only apparent quicker but more intensely.

While the exact causes of ischemic pain are not clear there are contributing factors which can be identified: the presence of chemical stimuli (such as bradykinin or histamines - which are released when cells are damaged mechanically or chemically), when there is a build up of lactic acid, and when there is a reduction in the amount of oxygen delivered to the cells.

The original injury site (where pain sensations were perceived) causes the muscular contractions, that leads to ischemic pain and maintenance of those contractions results in a vicious circle because pain is caused by those very contractions. Associated with this are shortening of muscles and restricted range of movement - these can also cause more pain. When muscles become hypertonic they are excessively tight, have a shorter resting length with the myofibrils packed too close together - this reduces circulation and leads to restricted oxygen flow, and therefore pain. The aim of treatment needs to be to break the cycle, find the contributing factors, the location and what aggravates or alleviates the pain. Myofascial release, ischemic pressure and passive and active stretching of specific muscle fibres, reducing joint stress, normalising tissues, along with deactivating trigger points are all key. An assessment of your range of movement will highlight any tight areas and where imbalances are present.

Returning to nociceptors, the stimulation of nociceptive nerve endings are how pain is felt and these nerve endings are found throughout the body - in bones, cartilage, ligaments, tendons, fascia, bursa and neural structures. So damage to any of these will stimulate the nerve endings and you will perceive pain.
The longer a site is stimulated, either through mechanical damage (stretched fibres/structures, compression or trauma) or by chemicals (histamine or inflammation), the greater the risk of developing altered movement and compensation patterns. Think about a time you injured only one arm or one leg; your body will try to protect that area by avoiding its use, so the other (uninjured) side has to adapt its movement patterns to cope with either a weaker or painful opposite. Your body will not be functioning in an optimally biomechanical way. Even if you are not aware you are doing this, it can be happening because it can all happen at a microscopic level. And this is where massage can help to eliminate imbalances that can lead to longer term issues - which you would notice. Whether the initial pain source is your joints, ligaments, muscles, tendons, fascia or neural structures is essentially not important - they are all interlinked and will affect their neighbours both close and distant. This is why a remedial massage therapist will work on your feet, hips, back and neck if you have a knee problem. The pain you initially felt causes muscle spasms and tension throughout your body, so while you think your knee is the cause (and it may be), treatment has to look at the body as one unit. For treatment to be successful the fascia and muscle imbalances/tightness need to be eliminated and range of movement restored to normal. Part of that treatment will be the elimination of trigger points as mentioned above, but those are a whole topic of their own and we'll blog about TPs separately soon.

I've mentioned pain being the result of injury, but that isn't always the case. Poor posture (sitting at a desk all day), oxygen depletion (perhaps because you are stationary for too long or have restricted circulation), heightened anxiety levels or just your emotional state - these are all significant enough to trigger muscular contractions in a specific part of your body which can bring on that cycle of pain. Toxins build up and the metabolism in that area becomes impaired, leading to further damage to cells in the area. If this occurs over a period of time, it can even lead to scar tissue build up.

So how do we fix these things? How do we eliminate the pain (which can range from debilitating to a slight niggle)? Well, we could take medication - either over the counter pain-killers, or prescribed medication. There are risks and side effects to any medication (always seek medical advice before taking any medication) which I don't need to go into here. We could remove the stimulus which is making us perceive and feel pain - sometimes easy, sometimes not - it all depends on whether that stimulus is obvious to us. We could also have some form of bodywork - the power of touch alone could be sufficient to relax someone enough to remove the pain source. Or perhaps you could have deeper, specific massage techniques which can be employed to deactivate those trigger points that are causing headaches, relax out spasming muscles and rebalance the body to return dysfunctional postural patterns back to functional efficiency. Whether the cause of pain is known or not it needs to be eliminated through intervention.

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