Massage Magazine
Expert Advice column, April 2008
by Erik Dalton, Ph.D.
Q: How can
manual therapies be used to help eliminate pain?
Erik Dalton
responds:
Working in the
pain-management field is a challenging, yet exceptionally
rewarding, experience. Clients suffering from chronic pain are
confronted by a unique disorder—a personal experience unlike
any other physical malady. While a broken bone can be
confirmed by an X-ray and an infection can be detected by a
simple blood test, there are no universally reliable tests
available to measure pain levels. Because of this, many common
musculoskeletal complaints are incorrectly assessed and
treated.
Typically, when
a person experiences a slight sacroiliac joint sprain it’s
often hard to pinpoint the exact pain site, since everything
in the back, hip and leg seems to hurt. It’s often necessary
to feel around the whole area to determine the exact site of
the pain's origin. Thus, to localize and identify the pain,
it’s usually necessary to draw on central nervous system (CNS)
modalities, such as sight, movement response and touch.
Recall what
happens when you pinch a worm—it curls towards the pinch. And
when holding a newborn baby, try this experiment: Place the
baby face down with the stomach resting in your palm, so its
back faces you. Allow the baby's hips to move, with each leg
straddling your arm. By running your finger down the back
about one inch lateral to the spine, you’ll see the Landau
reflex. The baby’s erector spinae muscles will automatically
contract on the side where the stimulus is applied. There is
very little difference between this reaction and the reaction
that occurs when a painful stimulus is applied to the spine
later in life: The erector spinae muscles, including the
transversospinalis, automatically and involuntarily contract
toward the side of injury.
In adults,
locked facet joints and strained spinal ligaments are major
culprits perpetuating this ingrained reflex. Reflexogenic
myospasm from motion-restricted joints results in decreased
oxygen supply to surrounding tissues and resultant toxicity,
adhesion and fibrosis.
Left
untreated, continuous neural bombardment triggers stubborn
pain-spasm-pain reflexes that amplify musculoskeletal tone
(protective muscle guarding), distort posture (functional
scoliosis) and up-regulate sympathetic nervous system activity
(anxiety). Regrettably, the brain has the ability to learn
these aberrant postural patterns as normal. Neuroscientists
label this condition—where distorted postures remain in the
body long after the original stimulus has been removed—as
spinal learning, reflex entrainment and neuroplasticity.
Deep intrinsic
(postural) slow-twitch muscles, such as the iliopsoas,
transversus abdominis and semispinalis, burn oxygen for fuel
(oxidative metabolism) and are fatigue-resistant when
exercised, stretched and maintained properly. We live in a
flexion-addicted society where sitting is the norm. Computer
addicts, folks who drive for a living and couch potatoes
constitute only a small group whose inactivity level causes
deep anti-gravity support muscles to neurologically shorten
and distort posture.
As the
pectorals overpower the lower shoulder stabilizers and the
trunk flexors overpower the hip extensors, weight shifts to
the fast-twitch extrinsic muscles, which burn glucose for fuel
(glycolic metabolism). Since extrinsic muscles aren’t designed
to battle gravitational exposure, weight soon shifts back to
the oxygen-starved and fatigued intrinsic muscles. Unable to
maintain the body’s anti-gravity support system, these
overworked postural structures reluctantly dump the
compressive load to the spine and pelvis.
This sets the
stage for what the medical establishment loosely calls
degenerative disc disease. As increased weight-bearing
flattens intervertebral discs and crams facet joints together,
the posterior longitudinal ligament becomes lax.
Forward-bending, twisting or whiplash incidents can tear the
ligament away from the bony margins and vertebral end plates,
causing internal pressure to fill the cracks with calcium or
bone spurs. Osteophytic spurs gradually begin to fill the
intervertebral foramina and can impinge on nerve roots or the
spinal cord (spinal stenosis).
This common
osteoarthritic condition is the number-one cause of long-term
neck pain. Fortunately, if discovered in the early stages,
systematic mobilization of fibrotic tendons, ligaments and
joint capsules often frees the restricted dural membrane and
offers some relief. But the condition can return unless
whole-body structure, function and balance are properly
restored.
Most of our
clients battling recurrent pain (including fibromyalgia,
chronic fatigue and backache) are trapped in either an
intrinsic or extrinsic state of collapse. Too often, we settle
for immediate symptom alleviation rather than digging for the
root of the problem.
As the great
Czech researcher Vladimir Janda, M.D., once said, “The
neuromusculoskeletal system must be assessed and treated as a
whole, with muscle dysfunction considered in relation to the
functional status of the whole motor system, including
articular and nerve structures. Any change in the statics or
dynamics of the distal trunk and lower extremities will, in
some way, be mirrored in the function of the upper complex,
and vice-versa.”
Traditional
massage of a peripheral pain site temporarily calms cutaneous
skin and fascial receptors, thus reducing superficial pain.
But to alleviate deep-seated, joint-complex pain, the client
must be actively involved.
For example,
many have acquired a habit of sitting and holding a telephone
on one shoulder while performing other tasks. Sustained
hypercontraction of the upper trapezius, levator scapula and
associated fascia causes cervical and thoracic facet joints to
lock closed on the ipsilateral side creating alterations in
normal mechanoreceptive input to the brain. To calm the
irritated articular receptors and release the accompanying
protective muscle guarding, the therapist must hold
superiorly-directed sustained pressure to deep
transversospinalis muscles (overlying the fixated joint),
while the client engages the area with some sort of movement.
Chin-tucking is an excellent enhancer for stuck thoracic
vertebrae, and pelvic-tilting helps mobilize fixated lumbar
vertebrae. The use of enhancers, such as pelvic-tilts for
low-back and pelvic pain, deep breathing for diaphragm/scalene
releases, limb movements for glenohumeral restrictions and
chin-tucking for cervical and upper thoracic restrictions,
normalizes afferent activity and helps break stubborn
reflexogenic pain-spasm-pain cycles.
To achieve a
noticeable reduction of increased excitability in the neuronal
pool, the pain-generating stimulus must be interrupted until
the memory burned into the nerve cells has been completely
forgotten. For many chronic-pain cases, a serial-type
deep-tissue therapy works best when clients are seen twice
weekly until hyperexcited receptors feeding the CNS are
quieted. This will eventually inhibit the chemical activation
of pain at the site of its peripheral stimulation.
Of course,
successful management of chronic pain depends on much more
than intellectual knowledge. It must be teamed with keen
observation skills, patience, compassion and a constant
reminder that the healer is, ultimately, within each client.
Therapists serve only as helpful facilitators in the ongoing
journey toward optimum health and they should gratefully
utilize the body’s innate self-regulatory system to help guide
the therapeutic processs.
Despite the
variety of pain-management approaches available in today’s
ever-expanding bodywork field, the therapeutic goal should
remain the same: restoration of maximal pain-free movement
within postural balance.
Erik Dalton,
Ph.D., created Myoskeletal Alignment Techniques and founded
the Freedom From Pain Institute. Dalton’s broad therapeutic
background in Rolfing and osteopathy is taught worldwide
through pain-management workshops and home-study courses
approved by the National Certification Board for Therapeutic
Massage and Bodywork, the Florida Board of Health and most
state-certifying agencies. Visit
www.erikdalton.com
to read additional articles or to subscribe to free monthly
pain-management newsletters.
Posted by
permission of MASSAGE Magazine (
www.massagemag.com
). Originally published in MASSAGE Magazine's Expert Advice
column, April 2008.
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