Thoughts on Massage, Physical Therapy, & the Origins of Pain
As many of my clients and co-workers know, I have recently begun coursework toward a DPT (Doctor of Physical Therapy) degree. This will be a several years long process for me, but I have already begun to get a sense of just how well massage therapy and physical therapy go hand in hand. Part of my training thus far has entailed quite a few hours of observation alongside physical therapists in both outpatient rehab clinics and inpatient acute care facilities. I have also been continuing my classroom education with additional courses in Anatomy & Physiology, Medical Terminology, and even a bit of Physics!
Massage therapy is continually becoming a more accepted form of medically necessary treatment for a range of complaints such as chronic pain, acute injury recovery, and motor vehicle accidents (MVAs). Therapists at Siskiyou Massage frequently work tandem with a physical therapist or chiropractor, tackling a client’s complaints from different angles. I have had the good fortune to see firsthand how PTs and massage therapists work similarly and differently, and this has started to give me new perspective on looking at pain in the body and where it stems from.
Physical therapists have a much wider range of tools than massage therapists, and their primary focus is often on restoring mobility while decreasing pain. We massage therapists have similar goals and can achieve comparable results, but with the primary tool being our hands. It’s rare that you’ll visit your physical therapist for 30-60 minutes of hands-on soft tissue manipulation, but PTs have the wonderful ability to perform detailed range of motion assessment, assign stretching and strengthening routines, and use tools such as traction machines, laser therapy, fitness equipment, and ultrasound to further recovery. So, where does massage fit into this picture? The answer is everywhere! With the detailed knowledge massage therapists have of soft tissues and the extensive time we spend with clients, massage therapists have a unique place in the healing process. A recent MVA client of mine was a perfect case to demonstrate how effective massage and physical therapy can be together.
My client had sustained severe whiplash in a car accident, and experienced debilitating headaches, loss of cervical range of motion, some pain in her right shoulder and occasional nerve pain down her right arm. Both her physical therapist and I began working to relieve tension in her neck and upper shoulders. The neck pain persisted despite her decreased tension, however, and she started having more frequent shooting pains down her arm into her hand. Interestingly, she was also developing a loss of strength in her right wrist. The client noticed that picking up something, such as a coffee cup, was difficult if not impossible on days when the nerve pain was at its worst. I decided to change my approach and investigate my client’s wrist and elbow joint (even though her primary pain was still in her neck), while the physical therapist decided to take a closer look at her shoulder and rotator cuff. I quickly discovered that my client’s wrist had very poor range of motion, and that the muscles going from her elbow to her wrist (the forearm flexors) were extremely tight. My hypothesis was that she had what is often called a “double crush” syndrome (due to the tight forearm and elbow flexors) involving one or more of the nerves that descend from her neck and provide sensation and motor control all the way down to her hand. My approach from that point on was to include detailed work at her elbow and wrist in addition to the cervical work I was already doing. I was hoping that this would free the nerve pathway, decrease her pain, and improve her motor control. The physical therapist, meanwhile, discovered that the client had sustained damage to her rotator cuff, and began a shoulder strengthening routine with the client as well as ultrasound therapy. This combined, new approach was the key to this particular client’s return to health. Freeing the client’s wrist and elbow tension provided her relief from her nerve pain from wrist to neck. The physical therapist’s shoulder-strengthening plan allowed for the client to have a more supportive shoulder girdle, taking some of the load off of her strained cervical musculature. The ultrasound helped to break up newly forming scar tissue and increase blood flow to the area.
So, where does pain originate? The best answer to that is, “It’s complicated!” A client presenting with pain in the neck (as above) may need extensive work down the forearm or across the pectoral area. Someone with sciatic-like pain could have decreased movement in joints of the lower leg thereby changing gait, tightening the glute muscles on one side, and pinching the sciatic nerve. As I continue to learn more about the body, I’m amazed at how incredibly complex humans are. It’s a wonder we can do all the things we do on a day-to-day basis. The down side of this complexity is that things are never as simple as they seem when we get injured. The source of pain can often be far removed from where we actually feel pain. My goal, always, is to address the area where pain is felt, but to look beyond that point to other areas that may be contributing to the problem. On that note, I’d better sign off to do some neck stretches after all this time at the computer!