By: Jeffrey J. Budzek, R.N. , L. M.T.
The classic pain spasm cycle has been a model used by massage therapists for decades. There are different variants of it, but the essence remains the same. Pain in an area generates messages to the brain, the response is tightening of the affected area in an attempt to prevent further injury. In many musculoskeletal conditions, this splinting process creates additional pain, which generates additional messages to the brain, causing more pain, and the cycle continues. By interrupting this cycle, the muscles should release.
If only it were that simple. This is only one aspect of the cycle. Massage therapist’s confronted with relieving muscular pain find that the areas of congestion created by the muscle malady is a far more complex chain of events. This complexity is the reason that so many different styles of bodywork therapy tout their litany of success stories. Each therapy addresses entirely different physiological systems, affecting one or two elements of this complex cycle achieving various measures of success. For instance; the fascial therapies affect the fascia, Swedish Massage affects the circulation, Trigger Point Therapies affect the neural system, and so on. This is why a new model is needed that is specifically applicable to the needs of the massage therapist.
The more elements of this complex pain cycle that are simultaneously addressed in therapy, the greater the success rate. This is what led me to develop a new muscular pain model which demonstrates all the elements of this Musculoskeletal Pain Cycle. This new paradigm creates a foundation for the massage therapist. From this foundation the massage therapist can formulate his or her own sequence of therapies in the Medical Massage session so as to best suit the needs of the client.
This new Musculoskeletal Pain Cycle;[ A very simplified illustration of it is shown below ]; displays the complex chain of events that usually manifest after an injury, illness, chronic condition or stressor. It must be noted at the outset that each element reinforces the other creating a snowballing effect. Also important is that any single element in this Musculoskeletal Pain Cycle, especially stress, can initiate this complex chain of events. The nine elements of the Musculoskeletal Pain Cycle, are:
PAIN: Excites the nerves, tightens muscles, activates trigger points, impairs circulation, and can profoundly effects body mechanics. Trigger point therapies, Swedish Massage, and Deep Muscle Therapies exhibit the best results for this element.
STRESSORS: Can be mental, emotional, or physical in nature. Stress can lead to all of the other elements, but especially to muscle tension, circulation, trigger points and pain. Client re-education of posture, sleeping position, and work ergonomics are some areas to review for this element.
INCREASED NEURAL ACTIVITY: Activates stress hormones and the sympathetic nervous system which directly affects muscle tonus, pain, stress, and Intra Articular Pressure. Trigger Point Therapies and specific applications of vibration and percussion yields good results here.
INCREASED MUSCLE TENSION: Directly affects the neural, fascial, circulatory and skeletal systems. Additionally, certain muscle tensions and postures are related to specific emotional states. The Deep Muscle Therapies, Swedish Massage, Trigger Point therapies, stretching techniques and Yoga work well on this element.
REDUCED LOCAL CIRCULATION: Affects muscle tonus, reinforces trigger points, and exacerbates the formation of fascial adhesions. Swedish Massage is the superior therapy for this element along with some of the Deep Muscle Therapies.
TRIGGER POINTS: Affect the muscle tension, circulation, the fascia and the neural pathways. There is debate as to what body mechanism is taking place in the de-activation of these areas. That being said, I have found the Trigger Point Therapies, Stretching and some specific Deep Muscle Techniques to be extremely valuable here.
FASCIAL ADHESIONS: They top off the formation of this capsule of congestion that occurs with the pain cycle. Adhesions directly affect all other elements and respond best to various Fascial Therapies, Stretching and the Deep Muscle Therapies.
INTRA ARTICULAR PRESSURE: This joint compression is a result of localized congestion and directly reinforces all the other elements. Stretching, Yoga and Articular Therapy are best suited for this element.
IMPAIRED BIO-MECHANICS: Is an applied compensation, either consciously or sub-consciously, in response to the whole muscle malady, which, not only reinforces it, but also creates imbalances in other areas of the body, consequently leading to the beginning of a brand new cycle and secondary area of pain.
As you can see, if a singular therapy was applied, [IE. Swedish Massage or Trigger Point Therapy], one or more of the elements of the Musculoskeletal Pain Cycle would be addressed, which would in turn affect several others, generating various results. But if the massage therapist uses a Multi Modality Medical Massage, addressing ALL of the elements simultaneously, the result is a reverse snowball effect.
One last item must be noted, the longer a muscular condition exists, the more compounded it becomes, affecting additional muscle groups, creating secondary pain areas, and increasing the duration of time it takes to reduce the original malady. In these cases both the original and secondary pain areas may need to be addressed simultaneously.
This article appeared in the NANMT, (National Association of Nurse Massage Therapists), offical news publication in 2004.